Housing Survey To Residents - Sample

Dear Resident, The number one concern of residents today is the impact of higher energy costs and the strain it places on our households. The Housing Division has been asked to compile data on energy/fuel costs for our off base residents to better gage the impact the increase is having on our members and their families. Please take a moment to complete the following questionnaire and email it to [email protected] You may also contact the Housing Services Office at 353-1660 or 353-1190 to provide information over the phone or in person at Building 3401 Santiago Road as soon as possible. All information to be included in the study must be received by close of business (1600) on 4 Nov 08. Your participation in this data call will help ensure that accurate information is captured and reported up the chain of command. Please be sure to report any improvements and/or upgrades you have completed to reduce your overall energy usage. Again, Thank you for your time and participation in the attached survey. Very Respectfully, Housing Division Fort Wainwright, Alaska

Rank: _____ Name: ________________________________ BAH with or without dependents: ____________ Military Spouse? _____, if yes: Rank:______ Square footage (approx): ____________ Monthly rent or mortgage: _____________ Does rent include utilities: _______ Heating type: _____________ Heating Fuel oil average cost for 1 year (approx):______________ Average gallons of heating oil per year (approx) _________ If not heating oil, source of heat (elec, wood, etc..): ____________ If not heating oil, average heating value cost per year: _______________ Average monthly electric cost per year: _______________

Actions taken to reduce heating costs, check all that apply: Upgrades to furnace: ___ Added insulation to home: ____ Window upgrade: _____ Garage door upgrade: ______ Lowered thermostat settings: ______ Other energy upgrade adjustments: _______________________________________________ Total cost of upgrades for energy conservation for past 3 years: ________________