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HTML Popup Type: esriServerHTMLPopupTypeAsHTMLText
color_code (type: esriFieldTypeString, alias: This Survey Template is designed to mirror the base "Unsheltered Survey" within the Counting Us app. The questions are color coded as noted below.
RED FONT = HUD required questions that are needed to produce the HUD Point in Time report.
PURPLE FONT = These are commonly asked research questions that can be removed without impacting any reporting or conditional logic.
BLACK FONT = Supporting questions designed to help improve the integrity of the data.
YELLOW FONT = Community custom questions., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
Introduction_and_Screener (type: esriFieldTypeString, alias: *Hello, my name is __________________ and I'm a volunteer for local outreach. We are conducting a survey to better understand homelessness in our community and improve programs. If you participate your responses will be kept confidential. You can choose to skip any question and your answers will not affect your eligibility for any compensation or services, and the information will not be shared with anyone outside of our team. I need to read each question all the way through. Can I have about 10 minutes of your time? *, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
interviewed_today_PIT (type: esriFieldTypeString, alias: Have you already been interviewed today for the Detroit's Unsheltered Homelessness Census Count?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
sleeping_location (type: esriFieldTypeString, alias: Where are you sleeping on the night of the Count?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Abandoned_building: Abandoned building], [Under_a_bridge/overpass: Under a bridge / overpass], [Jail: Jail], ... 15 more ...)
client_name (type: esriFieldTypeString, alias: What is your name?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
first_name (type: esriFieldTypeString, alias: First Name (or Initial), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
last_name (type: esriFieldTypeString, alias: Last Name (or Initial), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
prefers_not_to_provide_name (type: esriFieldTypeString, alias: Person prefers not to answer, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes])
if_hesistant_initials (type: esriFieldTypeString, alias: If hesitant, ask "What are your initials?", SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
gender (type: esriFieldTypeString, alias: What is your gender? (select all that apply), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
different_identity_desc (type: esriFieldTypeString, alias: If Different Identity, please specify, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
dob (type: esriFieldTypeDate, alias: What is your date of birth?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
dob_additional (type: esriFieldTypeString, alias: Alternative date of birth responses, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Person_doesnt_know: Person doesn't know], [Person_prefers_not_to_answer: Person prefers not to answer])
age (type: esriFieldTypeInteger, alias: If refused to answer date of birth, ask "How old are you?", SQL Type: sqlTypeOther, nullable: true, editable: true)
age_refusal (type: esriFieldTypeString, alias: If refused to answer age, "What age range do you fall into?", SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [<5: <5], [5-12: 5-12], [13-17: 13-17], ... 6 more ...)
race (type: esriFieldTypeString, alias: What is your race? (select all that apply), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
sexual_orientation (type: esriFieldTypeString, alias: Which of these options best describes your sexual orientation?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Lesbian: Lesbian], [Gay: Gay], [Bisexual: Bisexual], ... 5 more ...)
first_time_homeless (type: esriFieldTypeString, alias: Is this the first time you have been homeless?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
homeless_since (type: esriFieldTypeString, alias: How long have you been homeless this time? Only include time you spent staying in shelters and/or on the streets., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [0_to_3_months: 0 to 3 months], [4_to_6_months: 4 to 6 months], [7_to_11_months: 7 to 11 months], ... 3 more ...)
homeless_months_last_3_years (type: esriFieldTypeString, alias: How many months did you stay in shelters or on the streets over the past 3 years?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [0_to_3_months: 0 to 3 months], [4_to_6_months: 4 to 6 months], [7_to_11_months: 7 to 11 months], ... 3 more ...)
num_times_homeless_3_years (type: esriFieldTypeString, alias: How many separate times in the past 3 years have lived in a shelter, on the streets, or in a car?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Fewer_than_4_times: Fewer than 4 times], [4_or_more_times: 4 or more times], [Person_doesnt_know: Person doesn't know], ... 1 more ...)
num_months_community (type: esriFieldTypeString, alias: How long in months have you been in this community?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [0_to_3_months: 0 to 3 months], [4_to_6_months: 4 to 6 months], [7_to_11_months: 7 to 11 months], ... 3 more ...)
last_address (type: esriFieldTypeString, alias: Do you remember the address where you were living when you became homeless this time?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
page_3 (type: esriFieldTypeString, alias: *Next, I'm going to read you a list of "yes-no" questions about different situations you may be facing. The information you choose to share on these next questions will help our community better understand the specific services and resources that people in our community need.
Again, this survey is confidential, and your answers will not affect your eligibility for services or programs. And we can skip any question you don't feel comfortable answering. *, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
substance_use_disorder (type: esriFieldTypeString, alias: Do you have a Substance Use Disorder?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [No: No], [Alcohol_use_disorder: Alcohol use disorder], [Drug_use_disorder: Drug use disorder], ... 3 more ...)
substance_impact_independency (type: esriFieldTypeString, alias: If yes, is this a long-term disability that impairs your ability to hold a job or live independently?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
chronic_health_condition (type: esriFieldTypeString, alias: Do you have a Chronic Health Condition?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
chronic_health_impact_indep (type: esriFieldTypeString, alias: If yes, is this a long-term disability that impairs your ability to hold a job or live independently?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
mental_health_disorder (type: esriFieldTypeString, alias: Do you have a Mental Health Disorder?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
mental_health_impacts_indepen (type: esriFieldTypeString, alias: If yes, is this a long-term disability that impairs your ability to hold a job or live independently?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
physical_disability (type: esriFieldTypeString, alias: Do you have a Physical Disability?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
physical_disability_impacts_ind (type: esriFieldTypeString, alias: If yes, is this a long-term disability that impairs your ability to hold a job or live independently?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
developmental_disability (type: esriFieldTypeString, alias: Do you have a Developmental Disability?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
receive_disability_benefits (type: esriFieldTypeString, alias: Do you receive disability benefits?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
hiv_aids (type: esriFieldTypeString, alias: Are you living with HIV or AIDS?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
traumatic_brain_injury (type: esriFieldTypeString, alias: Do you have a traumatic injury to the brain?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
brain_injury_impacts_independ (type: esriFieldTypeString, alias: Do you feel this keeps you from holding a job or living in stable housing?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
domestic_violence_survivor (type: esriFieldTypeString, alias: Are you a survivor of domestic violence?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
domestic_violence_date (type: esriFieldTypeString, alias: If yes, when did the experience(s) occur?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Within_the_past_three_months: Within the past three months], [Three_to_six_months_ago_(excluding_six_months_exactly): Three to six months ago (excluding six months exactly)], [Six_months_to_one_year_ago_(excluding_one_year_exactly): Six months to one year ago (excluding one year exactly)], ... 2 more ...)
homeless_due_domestic_violence (type: esriFieldTypeString, alias: Are you experiencing homelessness because you are currently fleeing domestic violence, dating violence, or stalking?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
placed_foster_group_home (type: esriFieldTypeString, alias: Before age 18, were you ever placed in a foster home or a group home?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
veteran (type: esriFieldTypeString, alias: Are you a veteran? (served in the US Armed Forces OR been called into duty as a member of the National Guard or as a Reservist), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Yes: Yes], [No: No], [Person_doesnt_know: Person Doesn't Know], ... 1 more ...)
end_of_form (type: esriFieldTypeString, alias: *Those are all the questions I have for you. We realize that some of the topics covered are personal and can be difficult to think and talk about. We appreciate your willingness to participate tonight. Thank you for taking the survey! *, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
sensitive_disclaimer (type: esriFieldTypeString, alias: *Next, I'm going to read you a list of "yes-no" questions about different situations you may be facing. The information you choose to share on these next questions will help our community better understand the specific services and resources that people in our community need.
Again, this survey is confidential, and your answers will not affect your eligibility for services or programs. And we can skip any question you don't feel comfortable answering. *, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolNone
Prototype: