Jon's Class Survey

Survey for Jon Erickson's Class

1. Age
2. Gender
3. Number of people in household
4. Household characteristics
[ ] Individuals living alone
[ ] Married couple with children
[ ] Married couple without children
[ ] Other family household
[ ] Other nonfamily household
5. Employment Status:
[ ] Full-time (30-40 hrs/wk)
[ ] Part-time (< 30 hrs/wk)
[ ] Retired
[ ] In school, not looking for work
[ ] Unemployed, looking for work
[ ] Unempl., not looking for work
6. Occupation (previous if retired):
[ ] Agriculture
[ ] Manufacturing or Mining
[ ] Construction
[ ] Finance, Insurance, or Real Estate
[ ] Wholesale or Retail Trade
[ ] Transportation, Communication, or Utility
[ ] Education
[ ] Government (not education)
[ ] Student
[ ] Unemployed
[ ] Check if self-employed
7. Are you registered to vote?
[ ] Yes [ ] No [ ] Not a US citizen
8. Income: [ ] Family, or [ ] Pers.
[ ] Under $15,000
[ ] $15,000 - $30,000
[ ] $30,000 - $60,000
[ ] $60,000 - $120,000
[ ] Over $120,000
9. Education:
[ ] Graduate degree
[ ] Bachelor's degree
[ ] Associates degree
[ ] High school diploma
[ ] No high school diploma
10. Race and ethnicity:
[ ] White / Caucasian
[ ] Black / African
[ ] Hispanic
[ ] Asian / Pacific Islander
[ ] Other / Multi-racial
11. Housing:
[ ] Own home
[ ] Rent
[ ] Other
12. Mobility:
[ ] Own two or more vehicles
[ ] Own one vehicle
[ ] Own no motorized vehicles
[ ] Other means of transport

Thank you. Now I would like to ask you some questions about what contributes to your quality of life in your Burlington neighborhood. First, some questions on how you define your neighborhood.
13. Of the following regions, please number the top five that you most identify with as your home?
[ ] My neighborhood in Burlington [ ] New England
[ ] City of Burlington [ ] Northeastern United States
[ ] Chittenden County [ ] United States
[ ] State of Vermont [ ] North America
[ ] Other:
14. On this map of Burlington, please draw the boundaries that you consider to be your neighborhood?
INSERT MAP HERE
Next we will address four groups of questions about quality of life in your home and neighborhood. A fifth group of questions will be about your overall quality of life. For each of these questions, please use the following scale:
[5] Extremely good or strongly agree or definitely true
[4] Good or agree or true
[3] Average or neutral
[2] Below average or disagree or not true
[1] Poor or strongly disagree or definitely not true
I. The first group of questions is about personal and public investments in your home, lifestyle, and neighborhood.
15. To what extent do the things you own or rent (for example, your home, car,
furniture, clothes, etc.) contribute to your quality of life?
16. How would you rate the following list of items contributing to your quality of life? Also, how would you rank them from 7 (most important) to 1 (least important).
Ranking: Rating:
[ ] Home (either owned or rented)
[ ] Automobile or other (_____________) mode of transportation
[ ] Food and drink
[ ] Furniture, appliances, and other household goods
[ ] Clothing, shoes, jewelry, and other personal accessories
[ ] Entertainment goods (skis, bike, video games, etc.)
[ ] Other:
17. To what extent do the public investments in your neighborhood (for example,
streets, sidewalks, streetlights, parking, public septic, etc.) contribute to your
quality of life?
18. To what extent do private investments in your neighborhood (for example,
shops, restaurants, offices, etc.) contribute to your quality of life?
II. The second group of questions is about investments and access to the natural environment in or near your neighborhood.
19. To what extent does access to public open space in your neighborhood
(for example, parks, recreation paths, waterfront) contribute to your quality
of life?
20. How would you rate the following list of natural assets in your community
toward contributing to your quality of life? Also, how would your rank them
from 6 (most important) to 1 (least important)?
Ranking: Rating:
[ ] Air quality
[ ] Water resources (for recreation, scenery, wildlife)
[ ] Public open space
[ ] Noise in neighborhood
[ ] General cleanliness (for example, trash, grime, smell, etc.)
[ ] Other:
III. The third group of questions is about your personal well-being and investments made in yourself.
21. To what extent do investments made in yourself (for example, education,
job skills, health, spirituality) contribute to your quality of life?
22. Please rate how personally satisfied you are with the following?
Also, how would you rank the following in contributing to your quality of
life, from 5 (most important) to 1 (least important).
Ranking: Rating:
[ ] Job
[ ] Education
[ ] Health care
[ ] Mental and/or spiritual well-being (i.e., religion, meditation, relaxation)
[ ] Exercise
[ ] Other:
23. Do you have health insurance? [ ] Yes [ ] No
24. How many years have you been working at your current place of employment?
IV. A fourth group of questions is about your relationship with your family, friends, and community.
25. To what extent do relationships with your family and friends contribute to
your quality of life?
26. To what extent do interactions with people in your neighborhood contribute
to your quality of life?
27. How would you rate the following list of community resources toward contributing to your quality of life? Also, how would you rank them from 8 (most important) to 1 (least important).
Ranking: Rating:
[ ] Government services (ex. police and fire protection, city government)
[ ] Public schools (K - 12)
[ ] Colleges and universities
[ ] Neighborhood or street association
[ ] After school and/or youth activities
[ ] Clubs and other membership organizations
[ ] Religious or cultural organizations
[ ] Other:
V. Lastly, I have just a few final questions about your overall quality of life.
28. How would rate your overall quality of life?
29. Please distribute 100 points across the following regions according to their contribution to your overall quality of life?
[ ] My neighborhood in Burlington [ ] New England
[ ] City of Burlington [ ] Northeastern United States
[ ] Chittenden County [ ] United States
[ ] State of Vermont [ ] North America
[ ] Other: Total =
30. Please distribute 100 points across the following four categories according to their contribution to your overall quality of life.
[ ] Personal and public investments in your home, lifestyle, and neighborhood.
[ ] Investments and access to the natural environment in or near your neighborhood.
[ ] Your personal well-being and investments made in yourself.
[ ] Your relationship with your family, friends, and community.
Total =
31. Please distribute 100 points across the following categories according to how your spend your time during a typical week (Monday through Sunday).
32. If you were given a gift of $1,000, how would you spend or invest the money?
33. Are there other features of your life that we've missed or you would like to expand on that help define your quality of life?
Thank you very much for you time. The final results of this survey will be available at the following web address by January 15th: www.uvm.edu/~jdericks/QOL/. We will also make copies available through the Burlington Legacy Project in City Hall and neighborhood associations throughout the city. If you have any questions or concerns regarding this survey, please feel free to call my professor, Jon Erickson, at 656-3328.
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QUALITY OF LIFE SURVEY