1. How many years have you lived in West Hartford? Choose one Less than 5 years 5-10 years 11-15 years Over 15 years

2. With regard to your residence, do you Own or Rent

3. How many people live in your household? Adults Children

4. Do you have any children who are now attending West Hartford schools? If so, please indicate the schools:

Elementary Choose One Aiken Braeburn Bugbee Charter Oak Duffy Morley Norfeldt Smith Webster Hill Whiting Lane Wolcott American School for the Deaf Ben Bronz Academy Cedar Court Emanuel Synagogue Religious School Gengras Center for Exceptional Children Hartford Christian Academy Intensive Education Academy, Inc. Montessori School of Greater Hartford, Inc. Solomon Schechter Day School St. Brigid School St. Thomas the Apostle Renbrook School

Middle School Choose one King Philip Sedgwick Kingswood Oxford Renbrook American School for the Deaf Emanuel Synagogue Religious School Hartford Christian Academy Watkinson School St. Timothy Middle School St. Brigid School

High School Choose One Hall Conard American School for the Deaf Ben Bronz Academy Emanuel Synagogue Religious School Gengras Center for Exceptional Children Hartford Christian Academy Hebrew Academy of New England Intensive Education Academy, Inc. Kingswood-Oxford School Northwest Catholic High School Watkinson School

5. What is your approximate household income? Choose one Under $39,999 $40,000 to $69,000 $70,000 to $99,999 $100,000 to $149,999 Over $150,000

6. What is your employment classification? Choose One Professional Technical At home caregiver Laborer Student Unemployed

7. What is your gender: Male Female

8. Enter the year you were born

9. What is your trash collection day? Choose one Monday Tuesday Wednesday Thursday Friday

Thank you!