Relocation Survey

Please provide an answer to each question, as we will use this information to develop a relocation strategy that works for your household. You only need to complete this one time. If information changes, please reach out to us via email or by phone. This information is private and will not be shared. We will reach out using the phone number or email address you provide if we have further questions as we approach your relocation.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Apartment Size

Number of people

Smoking

Does anyone is your household smoke?

Yes

Medical needs

Do you have any medical needs or mobility limitations we may need to know about?

Do you have any reasonable accommodation needs (assist animal, 1st floor, grab bar, etc.)? Please list all reasonable needs:

Packing

Will you require any assistance with packing?

Yes

Transportation

Will you require assistance with transportation to your temporary housing?

Yes

Children in School

Do you have any children in school?

Yes

Do you have a pet in your household?

If yes, what type of pet?

What else do we need to know to make this process successful?