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SF-01-a

PARTICIPANT NO. 201_ - ______
This is your permanent number that will be used in all transactions

SURVEY FORM

(Teachers, Caregivers, Nurses, Therapists, Para-Sped Professionals)

Dear Participant:

Project: Happy Homes is the first and only housing-with-support community in the Philippines intended for families with special-need members/elderly and their support-providers. We are now moving towards the construction of the houses.

Last August 2016, we held the groundbreaking of My Big House, the heart of Happy Homes community. My Big House will serve as the central hub for all the programs and services that will be provided inside the community.

As we approach towards the construction of the houses, we hope to solicit comments and additional inputs from you. By participating in this survey, you can become part of the history of this master planned community. The survey data is later enriched and validated through continuing discussions with the members in the group. As of this writing, we have 25 active family-members. We still have available slots for 39 families of both recipients and providers.

Thank you for participating in this survey! You are not entering into any commitment when you fill up this form.

Participant (Head of the Family):

DATE TODAY:______

Last name: / First name: / Mr. 0
Mrs. 0 / Miss 0
Title____ / Phone
E mail address:
What are your skills/expertise/profession/talent?
What are your hobbies/interests?
Are you a member of ? ___SSS ___GSIS ___HDMF (Pag-Ibig)
Do you or any member of your family have any religious/political /social affiliations?
If yes, please indicate name of organization.

PART I – Housing Components

A. House Designs Based on the Number of Occupants

Kindly check which of the following house models suit your present need based on the number of occupants.

House Model / Description / Floor Area / Lot Area / Number of Occupant / My present family set-up needs this house design
(please check)
Bliss / Res-Com/with solar panel / 56 / 35 / 6
Felicity / Residential/with solar panel / 31.5 / common / 3
Jubilant / Commercial/with solar panel / 31.5 / common / 2

B. Commercial Business : Please check one business enterprise you wish to establish

Mini-grocery / Water Station / Drug Store
Business Center / Laundry Station / Clinic
Beauty Parlor / Ukay-Ukay / Computer Shop
Cafeteria / Bakery / Other, please indicate

PART II - Support Programs and Services: As service-providers, you shall have the opportunity to be hired as on-site providers to implement the following programs:

FOR SERVICE PROVIDERS
ALLOTMENTS / DESCRIPTION / Please check those you think families with special/additional needs members will benefit from
1. Psychoeducational Assessment/ Support Needs Assessment/ Career Preference Test/ Consultation/Counseling / Required as part of the Intake Process
2. Community Meals / This is the bond that holds the community together. New residents are also welcomed by holding a community meal.
3. Concierge Services / Service is provided to communicate needs of Recipients to Providers; for My Big House operations
4. Community Activities / Lifetime Provision
A. Psychosocial
B. Functional Academics
C. Self-Care
D. Vocational services/Actual Job Performance
E. Sports and Recreation
F. Spiritual Services
5. Housekeeping / A team of housekeepers is tasked to do cleaning of the houses, and other domestic chores.
6. Personal Assistant / Available 24/7; acts a first-responders in case of emergencies as they are trained in CPR.
7. Trained Nanny/ Caregiver / Continuous training is conducted to assure the families of availability when needed
FOR SERVICE PROVIDERS
ALLOTMENTS / DESCRIPTION / Please check those you think families with special/additional needs members will benefit from
8. Respite Care for
ISNs/Elderly / Families may entrust the ISN or elderly for brief period of time
9. Nutrition Advising / Service is available for individuals with special diets
10. Transportation Services / The community will maintain its own UBER for grocery shopping, malling, bank transactions, medical check-ups, etc.
11. Sheltered Employment / ISN’s will be hired as paid trainees or workers by the service –providers. Service providers are teachers, nurses, caregivers, therapists and other para-sped professionals who are occupying the residential-commercial units along the front strip. ISNs will also work as service crew in My Big House which is a mini-hotel that will offer bed and breakfast to guests.
12. Estate Planning / An essential tool that will ensure that the needs of the ISN/elderly will be available for the duration of their lifetime.
13. Financial Literacy
Seminars / Conducted regularly and participated in by teachers, therapists, nurses, caregivers, etc. This is in preparation for the possible business loans that will be made available to the service-providers.

PART III – My Big House: a house, a school and a mini-hotel. Resident Service-Providers are first priorities for the available job opportunities within the community.

MAJOR ROOMS / Please check those you think are necessary to implement the above-named programs and services.
CHILDREN'S ROOM
TEENS' ROOM
THE GREAT ROOM (SOCIAL AREA)
TEACHING KITCHEN
LIBRARY/ART STUDIO
ARTS & CRAFTS ROOM
HYDRO SPA
SOLAR PANEL
Would you suggest any additional function rooms?
ARE WE A MATCH? / YES / NO / MAYBE
Do you consider the following items as ideal characteristics of a housing-with-support community?
Our property is located in Tanza, Cavite. This 1-hectare site has beautiful views from one of the highest points in the barangay, so offering individual guided walks on the land is an important recruiting activity. Our land, founded on adobe stones, slopes gently towards the river. We plan to develop this area into a healing therapy area most suitable for building log cabins where therapeutic massage will be offered.
Accessibility: 40 kilometers from EDSA Santolan as starting point. The site is accessible via Slex (Susana Heights - MCX Exit or Daang Hari/Alabang) and via the Coastal Road (Cavitex).

Facilities nearby: SM Rosario, Robinsons, Puregold, McDonald, Jollibee, Kentucky, banks, schools and the Deped Stadium, the Medical City satellite clinic and general hospitals, resorts are a few minutes away.

Would you consider this a good site for a housing-with-support community?
I consider community path walks, conversational nooks and peaceful meditating/praying area, landscaped open areas, gathering nodes with play area, and sports facilities as necessary parts of the physical community structure.
Would you enjoy living in a neighborhood with clustered homes and walking from a central parking area, in order to have a pedestrian-friendly, car-free area? Roads and parking will remain at the perimeter to create a pedestrian-oriented neighborhood designed to encourage spontaneous and safe social interaction among children and adults and the elderly residents. At least some of the homes will be close to parking to ensure that those with mobility challenges are close to their vehicles.
Would a family with special/additional needs member want to live in a fully accessible community, ready to accommodate individuals in all stages of ability and disability?
Would a family with special/additional needs member like the idea of having their children be able to walk safely to their friend’s house without adult supervision?
Would a family with special/additional needs member feel secure to know that there is an available support system for their developmentally challenged child and for the elderly members as well in the same community?
For a family with special/additional needs member, is a community more important than a dream house?
Do you believe that Estate Planning and Care Planning are essential tools that families with special/additional need members need to establish to ensure their children’s security through the duration of their lifespan?
Questions for Potential Service-Providers:
Are you truly passionate about caring for Individuals with Special Needs and/or the Elderly?
Would you consider co-owning a residential-commercial unit built along the main road, knowing that the residents living in the community are already a captured market for the business enterprise you plan to establish? And that you as resident service-provider shall be given priority as on-site workers?
Will you be willing to take in a developmentally challenged adult as a trainee or as a paid worker under OneLife Foundation’s Sheltered Employment Program?
In every housing cooperative, there should be a savings and queuing program. It is important that the members who desire to live together in a housing cooperative community should enroll and begin to save and queue. Instead of depositing money in a bank, a member has an option to save it within the cooperative to be used for home savings in order to secure a slot. Is securing a slot in the first housing-with-support community in the Philippines, through building a home savings fund, an acceptable equity-building scheme for you?
Do you wish to continue receiving updates about
Project: Happy Homes?

THANK YOU FOR PARTICIPATING IN OUR SURVEY! J

Survey Form-RSProviders