RESIDENT PROFILE AND COMMUNITY ASSESSMENT FOR Columbia

Heights VILLAGE
Date: November 8, 2010

Dear Resident,

Resident Profile and Community Assessment

This is your opportunity to give feedback about your community; your views are important.

Columbia Heights Village is undertaking a comprehensive resident profile and community

assessment in order to better understand the community and meet specific needs.

This work is very important. It will be used to assess the make-up of the residents living at
Columbia Heights Village and the data will be used to access important and essential services and
resources for your benefit.

Please spare the time to fill this assessment in — it should only take about 10 minutes to
complete. Please complete it, even if you don’t think you have a need, and return it to the survey
taker or drop it off at the office located at 2900 14th Street NW.

Assessments are being sent to residents across Columbia Heights Village and all replies are dealt
with in the STRICTEST OF CONFIDENCE; they will only be reported as a group. NO PERSONAL
OR SPECIFIC INFORMATION IDENTIFYING YOU OR YOUR APARTMENT will be asked for or
gathered.

We need to hear from you to make your views count.

If you have any questions about this survey, please call Don Parker at (202) 422-0558.

Thank you in advance for your contribution to this work.

Sincerely,

Clark Realty Management, LLC and Columbia Heights Village Tenant’s Association
 2010 Resident Profile and Community Assessment

This assessment is to be completed by a household representative.

Please work your way through the form, taking care to check the box(es) next to the answer
that applies to you or to members of your household.
Please check one box only unless instructed otherwise.
All of your answers are STRICTLY CONFIDENTIAL.

Section 1: RESIDENT PROFILE

1.1 What is the number of person(s) living in the household?

1 2 3  4 or more

1.2 What is the age and gender/sex of person(s) living in the household?

AGE GENDER/SEX

1.3 What is the race of the person(s) living in the household (check all that apply)?

White, non-Hispanic  Asian/Pacific Islander non-Hispanic 

Black, non-Hispanic  Other (specify): 
Hispanic 

1.4 Number of person(s) living in the household 18 years of age or older

1.5 Total household income

$0 - $10,000  $20,001 - $25,000 

$10,001 - $15,000  $25,001 - $30,000 
$15,001 - $20,000  $30,001 and up 

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1.6 Current employment status (check all that apply for persons 18 years of age or older)

Not working/unemployed  Attending college/trade school 

Working part-time  Retired 
Working full-time  Other (explain) 

1.7 Which of the following schools does your school age child(ren) attend (check all that apply)?

School School
Bancroft  Shaw 
Bruce Monroe  Lincoln 
Cleveland  Banneker 
H.D. Cooke  Bell 
Marie Reed  Cardoza 
Oyster-Adams  Other (specify below): 
Tubman 

1.8 How long have you been a resident of Columbia Heights Village?

Under 1 year  11 – 15 years 

1 – 5 years  16 – 20 years 
6 – 10 years  Over 20 years 

1.9 Do you or any person(s) living in the household receive any of the following (check all that apply)?

Food Stamps  SSI 

Section 8 Voucher  TANF 
SNAP  WIC 
Other (specify): 

1.10 How would you rate Columbia Heights Village as a place to live?

 Excellent  Good  Fair  Poor  Don’t Know

Section 2: COMMUNITY ASSESSMENT

2.1 Workforce Development and Employment Opportunities

The following questions relate to your current employment status and programs and services
available to assist you in developing job skills or finding employment opportunities.

2.1.1 Are you currently employed?

 Yes  No

2.1.2 Are any person(s) living in the household that are age 18 or older employed?

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  Yes  No  Attending School/Other
2.1.3 If you answered “Yes” to question 2.1.1 or 2.1.2, state the reason for not being employed
(check all that apply):

Age  Laid-off 
Company Relocated  Business Failed 
Disability  Quit 
Downsizing  Retired 
Fired  Went to school 
Lack job skills  Other (specify): 

2.1.4 Are you familiar with the following programs/services:

2.1.4.a Hospitality Career Technical Education Program (Roosevelt Senior H.S.)

 Yes  No  I Don’t Know

2.1.4.b Construction Academy Career Technical Education Program (Cardoza Senior H.S.)

 Yes  No  I Don’t Know

2.1.4.c Pre-Apprentice Carpentry Program (Phelps Senior H.S.)

 Yes  No  I Don’t Know

2.1.4.d Transitional Employment Program (“Way-to-Work” Initiative)

 Yes  No  I Don’t Know

2.1.4.e Columbia Heights Career and Information Center

 Yes  No  I Don’t Know

2.1.4.f Senior Community Service Employment Program

 Yes  No  I Don’t Know  Does Not Apply

2.1.4.g Young Adult Internship Program

 Yes  No  I Don’t Know  Does Not Apply

2.1.4.h Summer Youth Employment Program

 Yes  No  I Don’t Know  Does Not Apply

2.1.4.i Green Team

 Yes  No  I Don’t Know
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 2.1.5 What types of Workforce Development/Employment Services would you like to see offered
by Columbia Heights Village (check all that apply)?

Dress for Success Program  Job & Career Fairs 

Employment Referrals  Job Training 
Entrepreneur Workshops  Resume Service 
Interviewing Workshops  Other (specify): 

2.2 Health and Wellness

The following questions relate to access to healthcare, health education and nutrition programs.

2.2.1 Are you and the person(s) living in your household covered by a health insurance plan?

 Yes  No

2.2.2 If you answered “No” to question 2.2.1, what are the reasons why you and/or any person(s)
living in the household do not have health insurance coverage?

Coverage expired  Not offered to part-time workers 

Not a citizen  Only available to family members 
Not employed  Too expensive 
Not offered by employer  Other (specify below): 

2.2.3 If you answered “Yes” to question 2.2.1, when a need for health services arises, how much
of the need is paid for by your insurance?

All needs are covered  No needs are covered 

Most needs are covered  Don’t Know or Not Sure 
Some needs are covered 

2.2.4 During the last 12 months, did a person(s) living in your household need to see a medical
professional for any reason?

 Yes  No

2.2.5 During the past 12 months have you experienced any of the following barriers to healthcare
(check all that apply)?

Lack of nearby healthcare provider  Unable to afford prescription 

Lack of transportation  Unable to leave work 
Needed daycare  Other (specify below): 

2.2.6 What type of store do you make your food purchases from (check all that apply)?

Giant  Neighborhood/Corner Store 

Local Farmer’s Market  Target 

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 Other (specify below): 

2.2.7 Estimate the percentage of your food budget spent by types of items purchased (must equal
100%):

Bread and Grains % Poultry (Chicken, Turkey) %

Dairy Products (i.e. Cheese, Milk) % Snack Foods %

Meat % Other (specify): %

2.2.8 Have you been referred to or the recipient of D.C. Child and Family Services (CFSA) in the
past 12 months?

 Yes  No

2.2.9 What types of Healthcare Services would you like to see offered by Columbia Heights
Village (check all that apply)?

Dental care/checkups  Pre-natal/Maternity care 

HIV/AIDS counseling  Substance abuse counseling 
Mental health services  Well-baby checkups 
Nutrition education  Other (specify): 

2.3 Education and Youth Development

The following questions relate to childcare, education and youth development opportunities for your
household.

2.3.1 Are you the parent or primary caregiver for children age 18 or younger living in the
household?

 Yes  No

2.3.2 If you answered “Yes” to question 2.3.1, who watches children age 18 or younger living in
the household during the day?

Child care center  Mother 

Father  Older children 
Friend or neighbor  Other family members 
Grandfather  School 
Grandmother  Other (specify): 

2.3.3 Are the children age 18 or younger living in the household during the day watched in your
home?

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 Yes  No

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 2.3.4 If you are unable to provide child care for children living in your household, what is the
reason that prevents you from doing so?

Do not need child care  Cannot find quality child care 

Cannot afford child care  Cannot find quality child care or afford it 
Other (specify): 

2.3.5 Do any of the children living in your household who are age 12 or younger experience any
emotional or behavioral problems (such as attention deficit disorder or depression)?

 Yes  No

2.3.6 Has any child living in your household who is age 12 or younger been given an
Individualized Education Program (IEP)?

 Yes  No

2.3.7 Do any child living in your household who is age 13 or older participate in a teen mentoring,
guidance or employment program?

 Yes  No

2.3.8 What types of youth education and development programs or facilities for youth would be of
benefit for children in your household age 18 or younger (check all that apply)?

Arts program  Pool 

Computer lab  Recreation center 
Homework assistance  Teen mentoring program 
Lower cost programs  Youth and teen center 
Parks/playground  Youth sports program 
Other (specify): 

2.4 Public Safety and Youth Crime Prevention

The following questions relate to issues concerning public safety and crime.

2.4.1 Do you feel safe living in Columbia Heights Village?

 Yes  No

2.4.2 If you answered “Yes” to question 2.4.1, what are the factor(s) that make you feel unsafe
(check all that apply)?

Assaults on residents  Loud music/noise 

Drug dealing  Presence of armed security 
Inadequate lighting  Presence of teens 
Other (specify): 

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 2.4.3 Would you say that the crime at Columbia Heights Village is more, less, or about the same
as it was when you first moved in?

 Yes  No

2.4.4 What types of youth crime prevention programs do you believe would be of benefit to
Columbia Heights Village (check all that apply)?

Evening sports leagues  Teen counseling programs 

Family support groups  Teen rap sessions 
Other (specify): 

2.5 Senior Needs

The following questions relate to needs of seniors (age 65 and older).

2.5.1 How many person(s) living in the household are age 65 and older (including yourself)?

2.5.2 Are the person(s) living in the household that are age 65 and older able to participate in
different activities?

 All the time  Most of the time  Some of the time  None of the time

2.5.3 If you answered “Some of the time” or “None of the time” to question 2.5.2, what are the
reasons why any person(s) living in the household age 65 or older (including yourself) are unable
to participate in different activities (check all the apply)?

Are alone/no companion  Mobility 

Cost  Prefer to stay home 
Finding transportation  Unavailability of activities 
Health issues  Other (specify): 

2.5.4 Does any person(s) living in the household age 65 or older (including yourself) required
skilled care that is provided either in the home or at some outside facility in the community?

 Yes  No

2.5.5 If you answered “Yes” to question 2.5.4, what type of skilled care to you receive (check all
that apply)?

Adult daycare  Senior community center 

Home healthcare  Other (specify): 
Nursing aide 

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2.5.6 What types of senior programs do you believe would be of benefit to Columbia Heights Village
(check all that apply)?

Activities/game room  Meal/nutrition program 

Bingo  Self-defense program 
Field trips  Wellness checkups 
Other (specify): 

THANK YOU FOR COMPLETING THIS QUESTIONNAIRE. YOUR RESPONSES ARE CONFIDENTIAL.

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