"BUILD QVIR" Survey - Quartz Valley Indian Reservation

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Modoc Lassen Indian Housing Authority

"BUILD QVIR"
An Economic Development Survey

* Indicates required field

Name *

First

Last

Your name is required to submit this form.

Phone Number (optional) *

1. What kind of business would you like to personally start? *

2a. Do you have any business ideas you would like QVIR to consider? *

Yes No

2b. If so, what are those ideas? *

3. Do you think QVIR should borrow money to start any businesses? *

Yes No

4a. How many QVIR Tribal members live in your house? *

4b. How many non-Tribal persons live in your house? *

4c. How many members of another Tribe live in your house? *

5. What is the age and gender of each person living in your house? (Please write the gender next to the age of each person.) *

Example: "2 yrs old / boy"

6. How do you feel about some QVIR Tribal departments doing business for profit? (Such as: EPA, Fire Hall, Gymnasium, and Education) *

7. What kind of job training would you participate in if QVIR provided it? *

8. If solar panel assembly was available, would you like to assemble them? *

Yes No

9. How do you feel about QVIR developing alternative energies? (Such as: Solar Panels, Wind Energies, Natural Gas, and Bio-fuels, etc.) *

10a. How many people contribute to the financial needs of your household? *

1 2 3 4 5 More than 5. I prefer not to answer.

10b. Are you able to meet your financial needs? *

Yes No

11a. Is access to educational opportunities an issue for you? *

Yes No

11b. Why or why not? *

Submit