____________________________________________________________________________________
SF-01-b
PARTICIPANT NO. 2016 - __________
This is your permanent number that will be used in all transactions
SURVEY FORM
(Individuals/Professionals/Volunteers)
Dear Participant:
Whether you are an individual, a professional, or a volunteer who wish to share your skills to the
organization, we request that you fill up this Survey Form. The results of this survey will be analyzed and
the data will be used to determine the skills/services that can be provided by the applicant, as well as,
the training/resources he/she needs.
If you are interested in co-owning a housing unit, please fill up Part II. The quantitative data will be used
to determine the housing needs of the participant.
Thank you for participating in this survey!
PART I
A. Participant:
Last name:
First name:
Mr. 
Miss 
Mrs. 
Title____
Phone
E mail address:
What are your
skills/expertise/profession/talent?
What are your hobbies/interests?
Page
1
What training/resources do you need
in the event that you will volunteer
your services to the foundation?
Survey Form-RSP_Revised April 2015
PART II – Proceed answering this part only if interested in co-owning a housing unit.
B. Household Composition
(List yourself on line 1, then list all of the other persons in your household who will be living with you.)
Full Name
Age
Sex
(surname first)
Relationship
to Applicant
Skills/Expertise/
Talents/
Profession
Membership in
any of the
following,
please indicate
(Pag-ibig, SSS,
GSIS, etc)
Yes No
Applicant
1.
Are you willing
to share these
skills to the
coop?
Yes No
2.
Yes No
3.
Yes No
4.
Yes No
5.
Do you expect the number of people in your family to change within the next 12 months?
(pregnancy, family joining, family leaving)  Check if yes. Please explain:
………………………………………………………………...……………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
C. Current Accommodation: (please describe your current accommodation as completely as possible by checking
and/or completing the information below.)
Do you:
 Rent
 Own
 Share Expenses
Please state your monthly rent:
 Have Free Accommodation
 Live in a Co-op
P
Describe your current accommodation.
(Put )
 Apartment
 Single Detached House
 Duplex/Row House
 Townhouse
 Condominium
 Other (Please explain)
Preferred number of bedroom/s
Page
No. of Bedroom/s your household presently occupies:
2
Are you willing to live in a residential-commercial
townhome located at Tanza, Cavite?  Yes  No
Survey Form-RSP_Revised April 2015
Does your present accommodation have a:
Bathroom
 Private
 Shared
 None
Kitchen
 Private
 Shared
 None
Laundry
 Private
 Shared
 None
Outdoor play area
 Yes
 No
 Yes (It is important that you list all pets)
Do you have any household pets?
 Dog
 No
Type/Breed (Please indicate):
Other pet/s (please indicate)
 Yes
Are you willing to give up your pet?
 No
D. Finances:
How much are you willing to pay for savings for housing per month?
P200-P300

P1,250-P1500

P2,251-P2,500

P301-P500

P1,501-P1,750

P2,501-P2,750

P501-P750

P1,751-P2,000

P2,751-P3,000

P751-P1,000

P2,001-P2,250

How much are you willing to pay for housing amortization per month?
P1,000-P1,500

P2,001-P2,500

P3,001-P3,500

P4,000-P5,000

P1,501-P2000

P2,501-P3,000

P3,501-P4,000

P5,000-P6,000

E. Business Plans:
Please check which business line you wish to establish:
Grocery

Beauty Parlor/Spa

Internet Cafe

Laundry

Barber Shop

Medical/Dental

Pharmacy

Restaurant

Other(pls indicate)

Water Station

Business Center

 No
 No
 No
 No
 No
 No
 No
THANK YOU FOR PARTICIPATING IN OUR SURVEY! 
Survey Form-RSP_Revised April 2015
3
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
Page
Are you willing to live in a coop community?
Are you willing to abide by coop rules and regulations?
Are you willing to take part in Savings for Housing Program and pay monthly savings?
Are you willing to wait in a savings queue program?
Are you willing to attend orientation meetings for housing?
Are you willing to attend workshops for housing?
Will you be willing to take in a developmentally challenged adult as a trainee or as
a paid worker under the Foundation’s Sheltered Employment Program?