Community Survey
To be filled out by one community member. Outside of the request for
general information, the community data is divided up into data
referring to four different types of capital. An attached sheet
provides a definition for each of the types of capital.
Where necessary or desirable, please feel free to add additional
information on the back of this sheet.
General Information
Name of Community: __________________________
Location (City, State/Country): ________________________________
Year Community was Initiated: ___________ Year
Occupancy Began: ___________
Built Capital Information
Number of Housing Units: __________ Number of Other
Buildings: _________
Estimated Value of Buildings and Infrastructure: _____________
Referring to final budgets would be just fine. If
costs are from the past, please note this (e.g. 1981 dollars).
Estimated Building Space per Person: _________________
Per Capita Square Footage
Building Energy Use per Person: _____________
An approximate monthly average would be great.
What percentage of energy used is from renewable resources: __________
What percentage is from on site sources such as wood or solar:
__________
What building materials used came from local and/or sustainable sources:
What infrastructure exists within the community to process waste:
e.g. composting systems, composting toilets,
artificial wetlands, septic systems, etc.
Please feel free to comment on any other elements of built capital that
may be of interest such as rainwater catchment, central heating
systems, etc.
Human Capital Information
Total Community Population - Adults: _________
Children: __________
If a significant portion is transient, such as
interns, volunteers, or visitors, please note on back.
Among "permanent" members, please estimate the average length of
residence: _________
Please estimate the percentage of adult members with the following
levels of education:
High School Degree: _________ Bachelors Degree:
____________
Graduate Degree: __________ Completed Apprenticeship
or equivalent: ____________
Please rank community diversity in each of the following categories:
Non-existent = complete
homogeneity Low = <10% of
population varies from dominant category.
Medium = 10 - 30% of population
varies High = >30% of population varies
(Please just make you best estimation.)
Age Diversity: Non-Existent ___ Low
___ Medium ___ High ___
Income Diversity: Non-Existent ___ Low
___ Medium ___ High ___
Racial/Ethnic Diversity: Non-Existent ___
Low ___ Medium ___ High ___
Sexual Orientation Diversity: Non-Existent
___ Low ___ Medium
___ High ___
Social Capital Information
How many communal meals are held each week: ___________
How are decisions made within the community:
What is the ownership structure:
What percentage of housing units are resident-owned? _________
What percentage are rental units? _________
How many hours a week of labor are expected of community members:
____________
Beyond this, please estimate additional time people give to the
community: ____________
Do you have any internal systems to facilitate the exchange of goods
and services:
e.g. internal currencies, LETS, etc.
What process exists for accepting new members:
Is there a unifying vision that all members ascribe to:
e.g. sustainability, religion, spiritual practice,
etc.
Natural Capital Information
What is the total area of land that your community owns: __________
What percentage is - Developed: _____ Agricultural:
______ Natural: _______
What percentage of your agricultural land is in production: _______
What percentage of your natural land is managed woodlot: _______
What is the estimated market value of the community's land holdings:
__________
What percentage of the community's food is produced on site: _________
What percentage of solid waste is treated or recycled on site: _______
Is wastewater treated on site: ______ If yes, how?
What is the estimated water use (gal/person/day): _______
Please describe any community efforts to reduce air emissions:
catalytic wood stoves, car pooling, electric
vehicles, etc.