| Identification | Entered by (name) | | |
| Name(s) and age(s) of individual(s) at location being described (list primary contact person first) | | |
| Contact info and preferred method (phone #, email address, etc) | | |
| Organization of person being surveyed (if appropriate) | | |
| Type of location being descibed | | |
| Other | |
| Location name (if appropriate) | | |
| Size of population covered by survey | | |
| Street Address | | |
| City | | |
| Location | | |
| NEIGHBORHOOD RESILIENCE ASSESSMENT |
HOUSING:
How secure and safe do people feel in their homes?
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