Full Name
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Email
*
Phone
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Preferred Method of Contact: (Email, Phone, Text)
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Phone
Email
Text
Languages Spoken:
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How long have you lived in Altadena? (Years/Months)
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Do you own or rent property in Altadena?
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Own
Rent
What type of property do you own or occupy?
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Do you currently have homeowners or renters insurance?
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Yes
No
Was your property affected by recent fires or other disasters?
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Are there specific concerns you have about preserving your property or neighborhood?
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What are the biggest challenges you currently face as a property owner/resident? (Select all that apply)
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Housing affordability
Property maintenance
Disaster preparedness and recovery
Access to resources or support programs
Other (please specify)
What kind of assistance would be most helpful to you?
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Are you interested in participating in community programs or events?
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Do you feel prepared for potential natural disasters (e.g., fires, earthquakes)?
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Have you received assistance from any disaster recovery programs? (Yes/No)
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Do you have access to a safe and reliable emergency evacuation plan?
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Yes
No
What are your top concerns for the Altadena community?
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What areas would you like the group to focus on?
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Would you like to volunteer with or support community initiatives? (Yes/No)
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What types of funding or resources would benefit you and your property most?
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Are you aware of any existing programs or grants that could benefit the community? (Yes/No)
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What additional support or resources would you like to see for the Altadena community?
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Do you have any suggestions for improving the neighborhood or addressing local challenges?
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Optional Demographic Information
(For grant applications and program
planning)
Age Group:
Ethnicity/Race:
Household Income Range:
Would you like to receive updates or newsletters from us?
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Yes
No
Do you consent to having your information used for community improvement purposes?
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Yes
No
