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2025 Point-in-Time Count
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10 Year Plan to End Homelessness
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Speak Up! Lived Experience Survey
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Indicates required field
Name
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First
Last
Age Group
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Please select one
Under 18
Age 18-24
Age 25-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
Prefer not to say
Part A. Your Experiences
1. Which of the following describe your experience(s)? (check all that apply)
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Currently homeless
Homeless in the past
Currently living with friends or family
Currently in danger of losing my housing
Have been in danger of losing my housing in the past
2. Which of these places have you ever slept because you had no place else to go? (check all that apply)
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Outside
In a vehicle
In a shelter
Stayed with friends or family
Part B. Participation Preferences
3. Which of the following opportunities to provide input on homeless and housing would you like to be invited to participate in? (check all that apply):
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Be part of a focus group (a group that meets once to answer a specific set of questions or provide an opinion on a certain topic)
Be part of a Lived Experience Advisory Board (a group that meets monthly to provide feedback on things like plans for services and may also go to other meetings to represent the Lived Experience Advisory Board)
Answer surveys (like this one, but about actual services)
Be interviewed one-on-one (sit down with an interviewer to provide your feedback on a particular topic)
Sharing my story (telling your story to a group, don’t worry – we’ll help you prepare!)
None of these
Part C. Demographics
Why are we asking about this? We want to make sure that homeless and housing services work for everyone, so having this information helps us make sure we get feedback from a lot of points of view. If you prefer not to answer one or both of these questions, just leave them blank.
4. What is your race/ethnicity?
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5. What is your gender?
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6. What is your sexual orientation?
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Part D. Contact Information
7. If you have a phone number, enter it here:
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8. If you have an email address, enter it here:
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9. If you don’t have a phone number or email address, please let us know the best way to get in contact with you here:
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Part E. Additional Information
8. (OPTIONAL) Is there anything else you want to tell us about you, your experiences, your opinions or your ideas? If so, please enter it here:
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Submit
