Relocation Questionnaire

1 Start 2 Complete

Name: *

First and Last

Address: *

Street Address, City, and Zip (remember to include unit #)

Are you filling out this form for just yourself or for your entire household? *

Myself

My Entire Household

How many & what sizes of beds will your household require for relocation? *

Do you have family & friends that you are able to stay with? *

Do you have your own transportation? *

Yes

Would you be comfortable using the local bus system? Do you have other ways of getting where you need to be? *

Do you have any pets? *

Yes

How many and what kind of pets? *

Do you have someone who can take care of your pets while you relocate? Do your pets need to go outdoors? *

Would you prefer to stay with family/friends and receive a daily stipend or in an apartment in the south end of Burlington (near T.J. Maxx)? *

Is there any other information that you think would be helpful for us to know for your temporary relocation?

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