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Questionnaire on Home Choices
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Questionnaire on Home Choices
We want to know about you because we are forming groups of like-minded families to work together. The more we know about you the more we can help!
1. Age of Child
My child is:
pre-teen (12 years of age or younger)
young adult (18-25)
adult (26 or older)
1a. Child's gender:
2. My child's disability is:
3. Level of independence
My child requires:
Limited care and supervision. Can care for self. No behavior problems. Will thrive in home like environment.
Regular care, supervision, and incidental training needs. Has some self-care skills and needs minimal assistance with activities of daily living. No major behavior problems, but may show mild behaviors (teasing, screaming, resistive) or mild non-compliance. Will thrive in home like environment.
Significant care, supervision, and ongoing training. Has significant deficits in self-help skills, and/or some limitations in physical coordination and mobility, and/or disruptive or self-injurious behavior.
Constant care, supervision, and professionally supervised training. Has deficits in self-help skills, and/or severe impairment in physical coordination and mobility, and/or severely disruptive or self-injurious behavior.
4. Timing of possible transition
I can imagine my child transitioning from home:
As soon as possible
In the next few years
5 – 10 years from now
More than 10 years from now
5. To ensure a spot for my child
I would consider purchasing a place before my child is actually ready to transition, and renting it out until we are ready.
6. LU Community concept
I think the LU Community concept is:
Interesting. For the right property, I would be prepared to invest.
A possiblity for my child. Need much more information.
Not of interest, thanks. Just looking.
7. Money, Honey
For the right property, I could find some money to secure a home for life for my child. I have or could finance within a reasonable time:
Less than $100,000
I am unable to pay but would like to be on a renters’ waiting list.
Not interested. Thanks, anyway.
Would you be willing and able to pay a non-refundable deposit of $10,000 to secure a place for your child. It would give us cash to complete our pre-closing inspections.
Yes. I would consider paying a $10,000 deposit to reserve a place for my child.
I am not ready to reserve a place, but will make a tax-deductible donation to help defer costs.
No. Sorry. I prefer to watch.
9. Volunteer time
Are you ready to devote volunteer time to this effort?
Yes, now, at the LU level, as advisor or committee member.
Yes, once a suitable property is found.
Maybe. It depends on my other time commitments.
No. Sorry. Busy.
10a. Integrated rural community
Where would you rank an intentional community in a rural setting administered by LU (such as Clearwater Ranch near Cloverdale)?
10b. Cluster of single-family homes
Where would you rank a cluster of single-family homes in a suburban area administered by LU?
10c. Multi-Unit apartments
Where would you rank a shared apartment in an apartment building in which neurotypical tenants may also live, close to shops and other amenities (less rural and more urban) administered by LU?
For the right property, I could see my child living this distance from our home:
30 minutes or less
Up to 1 hour
1 – 2 hours
Distance matters less than finding a suitable place
11a. City in which you reside (helps us figure out acceptable distance)
First Parent Phone
Second Parent Name
Second Parent Phone
(if more than one email, put a ; [semicolon] between each)
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2625 Alcatraz Avenue #335, Berkeley, CA 94705
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