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Paper Forms Housing & Community Development Survey

  1. The City of Dubuque receives Community Development Block Grant (CDBG) federal funds each year for housing and community development projects. The Housing and Community Development Department want you to have a voice in how the City invests this money. Please assist us by filling out this survey.
  2. In your responses below, which area of the City of Dubuque are you addressing?*
  3. If you are addressing a specific neighborhood, please mark all that apply.
  4. Income Chart
  5. What is your race (select all that apply)
  6. What is your ethnicity?
  7. What is your age?
  8. 1. Suitable Living Environment:
    For each of the following categories, please rate every item by checking the appropriate box indicating the level of need you see in our community.
  9. Community Facilities
  10. Senior Center
  11. Youth Center
  12. Child Care Center
  13. Homeless Facility
  14. Park and Recreational Facilities
  15. Health Facilities
  16. Community Center*
  17. Neighborhood Facilities
  18. Parking Facilities
  19. Other
  20. Infrastructure
  21. Accessible Curbs
  22. Water/Sewer
  23. Street/Alley
  24. Street Lighting
  25. Sidewalk Improvements
  26. Public Wall/Steps
  27. Drainage
  28. Other
  29. Special Needs
  30. Disabled Centers/Services
  31. Accessibility Improvements
  32. Domestic Violence Facilities
  33. Homeless Shelters
  34. Other

  35. Public Services
  36. Youth Services
  37. Mentoring Services
  38. Health Services
  39. Mental Health Services
  40. Substance Abuse Services
  41. Elderly Services
  42. Homeless Services
  43. Education
  44. Recreational Programs
  45. Child Care Services
  46. Transportation
  47. Neighborhood Services
  48. Crime Prevention
  49. Leadership Development
  50. Other
  51. 2. Decent Housing:
  52. Affordable Single Family Housing
  53. Affordable Rental Housing
  54. Housing for Disabled
  55. Homeownership Assistance
  56. Residential Rehabilitation
  57. Senior Housing
  58. Code Enforcement
  59. Historic Preservation
  60. Lead Paint Removal
  61. Fair Housing
  62. Tenant/Landlord Counseling
  63. Other
  64. 3. Creating Economic Opportunities:
  65. Business and Jobs
  66. Workforce Training
  67. Local Business Support
  68. Summer Youth Employment
  69. Job Readiness Skills
  70. Technical Assistance for Business
  71. Financial Assistance for Business
  72. Micro-Enterprise Assistance
  73. Job Creation/Retention/Training
  74. Attracting New Businesses
  75. Other
  76. 4. Area of Interest
  77. Thank you.
    Thank you for taking a few minutes of your day to complete this survey. The results of the survey will be compiled and presented to the Community Development Advisory Commission and considered during the development of the 5 year Consolidated Plan for the use of CDBG funds.
  78. Leave This Blank:

  79. This field is not part of the form submission.