1.0 Some Family/Household information:

Respondent  1 surname:
Respondent  2 surname:
Respondent 1 first name:
Respondent 2 first name:
email address:	*
Are you a member of Ecocom Solutions Inc.	Select Yes No
Country:
Suburb:
State:
Family country/region origin:
Current housing:	Select Home owner Renting
Household Information:	Gender		Age
Respond.  1	Select Male Female
Respond.  2	Select Male Female
Member 3	Select Male Female
Member 4	Select Male Female
Member 5	Select Male Female
Member 6	Select Male Female
Member 7	Select Male Female
Member 8	Select Male Female
Member 9	Select Male Female
Number of children:	Select expecting 0 1 2 3 4 5 6+
Trade/Profession:
Respond. 1
Respond. 2
Households skills that may be useful to project:
Interested in having your skills set made available to other members from a networking point of view?	Select Yes No
2.0 Current Level of Commitment
Do you plan to live at Somerville?		Select Yes No Uncertain
Planning to move in when?

If you are uncertain about living at Somerville please select the top three items below that would influence your family's decision in making a commitment to live at Somerville.

Select Sustainability Guidelines Lot price Timing Income / Employment Lot characteristics Dogs permissibility Business opportunity Village facilities Conflict resolution details By laws details Ecovillage design Decision making details Our/my finances Select Sustainability Guidelines Lot price Timing Income / Employment Lot characteristics Dogs permissibility Business opportunity Village facilities Conflict resolution details By laws details Ecovillage design Decision making details Our/my finances Select Sustainability Guidelines Lot price Timing Income / Employment Lot characteristics Dogs permissibility Business opportunity Village facilities Conflict resolution details By laws details Ecovillage design Decision making details Our/my finances
Any comments / thoughts:
Will you require low cost or affordable housing?	Select Yes No
Does any member of your family have special needs	Select Yes No
If yes, please provide details
Assuming all goes well and lots will be available to start construction of houses towards the end of 2005, when do you plan to start construction of your house at Somerville?		Select As soon as possible Depends on finances Within 12 months Between 12 to 24 months Unsure
Are you planning to owner build?		Select Maybe Yes No
3.0 Desired Level of Involvement
There are a number of community consultation workshops which will take place in the next 6 months covering the items listed below. Please indicate your level of interest for each of these community workshops:
Lot information and layouts		Select Not interested Attend if convenient Attend at all costs
Village centre design		Select Not interested Attend if convenient Attend at all costs
Ecovillage infrastructure design		Select Not interested Attend if convenient Attend at all costs
Body corporate by laws / governance		Select Not interested Attend if convenient Attend at all costs
Interim Community Building		Select Not interested Attend if convenient Attend at all costs
Economic/enterprise development		Select Not interested Attend if convenient Attend at all costs
Sustainable development guidelines		Select Not interested Attend if convenient Attend at all costs
Conflict and dispute resolution		Select Not interested Attend if convenient Attend at all costs
A range of other activities will be taking place over the next 12 months. Please indicate your level of interest and capability for being involved in these activities:
On site construction of project site office		Select Not interested Attend if convenient Attend at all costs
Construction of Interim Community Building		Select Not interested Attend if convenient Attend at all costs
Property land care and maintenance		Select Not interested Attend if convenient Attend at all costs
Establishment of vegetable gardens		Select Not interested Attend if convenient Attend at all costs
4.0 Lot, House and Cluster Preference Information
In communal areas are you likely to engage in any of the following:
Vegetable growing		Select Maybe Yes No
Fruit tree growing		Select Maybe Yes No
Stock herding		Select Maybe Yes No
Other activities - please provide details:
In your own home or on your own  yard are you likely to engage in any of the following:
Vegetable growing		Select Maybe Yes No
Fruit-tree growing		Select Maybe Yes No
Animal feeding / handling		Select Maybe Yes No
Manufacturing		Select Maybe Yes No
Provide visitor accommodation		Select Maybe Yes No
Operate a home based business		Select Maybe Yes No
Which type of lot which you prefer		Select Cleared Tree block Either
Considering that you are likely to have obligations to assist in maintenance of community-owned facilities or land, but that you will be solely responsible for maintenance of your own lot , please specify your preferred lot size.
Lot size preferred		Select 400 sqm or less 400 to 600 sqm 600 to 800 sqm 800 to 1000 sqm 1000 to 1500 sqm 1500 to 2000 sqm Greater than 2000 sqm
What price are you prepared to pay for your lot?		Select $45,000 to $55,000 $55,000 to $65,000 $65,000 to $75,000 $75,000 to $85,000 $85,000 to $95,000 $95,000 to $105,000 Greater $105,000
Please indicate home size you are hoping for in the ecovillage		Select Terrace or Duplex Home Single Bedroom Home Two Bedroom Home 3 or 4 Bedroom Home 5 or more Bedroom Home Shared Accomodation
All toilets at Somerville will be composting toilets. Is this acceptable to you?		Select Yes No
What is your preferred minimum distance between your home and your nearest neighbour?		Select 5 to 10 m 10 to 15 m 15 to 20 m 20 to 25m 25 to 30 m 30 to 35 m 35 to 40m 40 to 50 m Greater than 50 m
5.0 Economic / Enterprise Information
Which best matches you household income level		Select Less than $5000 $5,000 to $15,000 $15,000 to $25,000 $25,000 to $35,000 $35,000 to $45,000 $45,000 to $55,000 $55,000 to $65,000 $65,000 to $75,000 $75,000 to $85,000 Greater than $85,000
If you purchase a lot and build a house at Somerville what percentage of the total cost will you be required to finance?		Select Up to 10% 10 to 30% 30 to 50% 50 to 70% 40 to 50% 70 to 100%
Do you need to generate an income to sustain yourself ?		Select Maybe Yes No
Are you planning to work for yourself from within the ecovillage?		Select Maybe Yes No
If so, what type of business
Prime motivation for doing this?
Are you planning to employ other people?		Select Maybe Yes No
What support services or products will you require in order for your business to succeed?
Will you require some capital/loan funds to evolve your business?		Select Maybe Yes No
What do you see as the main obstacle for you to move forward on your business idea?
In order to prevent economic leakage occurring from the ecovillage it would be beneficial for us to understand likely community expenditure habits. If you could provide as much information as possible below, it would help in this process.
Please provide monthly household estimates for the items below:
Groceries (excl fresh produce)		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Fruit and vegetables		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Meats poultry and fish		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Insurance - home, contents, car etc		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Telephone - including mobiles		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Internet access		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Car repairs and maintenance		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Petrol		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Car finance		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Personal grooming		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Personal health - all inclusive		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Entertainment		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Gifts		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Holidays and travel		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Education and further studies		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Gardening		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Power and gas		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
Clothing		Select 0 to $50 $50 to $100 $100 to $150 $150 to $200 $200 to $250 $250 to $300 $300 to $350 $350 to $400 $400 to $450 $450 to $500 $500 to $550 $550 to $600 $600 to $650 $650 to $700 $700 to $750 $750 to $800 $800 to $850 $850 to $900 $900 to $950 $950 to $1000
6.0 Village Design Preferences
Which of the following facilities would you like to see in the village centre?
		Absolutely not  <================>  Absolutely
Business enterprise centre
Swimming hole/pool
Visitor accommodation
Cafe/Restaurant
Community building
Playground
Sport facilities
Village green
Education /learning centre
Shop
Other - please specify
Which of the following services/facilities would you like to have access to within the ecovillage?
Bakery		Select Absolutely not No Impartial Yes Absolutely
Corner shop		Select Absolutely not No Impartial Yes Absolutely
Mains power supply		Select Absolutely not No Impartial Yes Absolutely
Information centre		Select Absolutely not No Impartial Yes Absolutely
Market garden /fresh produce		Select Absolutely not No Impartial Yes Absolutely
Orchard		Select Absolutely not No Impartial Yes Absolutely
Reticulated water supply		Select Absolutely not No Impartial Yes Absolutely
Health / healing centre		Select Absolutely not No Impartial Yes Absolutely
Hire shop		Select Absolutely not No Impartial Yes Absolutely
Solar power		Select Absolutely not No Impartial Yes Absolutely
Storage units		Select Absolutely not No Impartial Yes Absolutely
Landscaping supplies		Select Absolutely not No Impartial Yes Absolutely
School centre		Select Absolutely not No Impartial Yes Absolutely
Markets		Select Absolutely not No Impartial Yes Absolutely
Accounting / tax services		Select Absolutely not No Impartial Yes Absolutely
Business planning services		Select Absolutely not No Impartial Yes Absolutely
Internal phone system		Select Absolutely not No Impartial Yes Absolutely
Car sharing / pool system		Select Absolutely not No Impartial Yes Absolutely
Insurance provision		Select Absolutely not No Impartial Yes Absolutely
Car maintenance services		Select Absolutely not No Impartial Yes Absolutely
Computer support services		Select Absolutely not No Impartial Yes Absolutely
Healthcare		Select Absolutely not No Impartial Yes Absolutely
Clothing		Select Absolutely not No Impartial Yes Absolutely
Internet access		Select Absolutely not No Impartial Yes Absolutely
Video / DVD Hire		Select Absolutely not No Impartial Yes Absolutely
Firewood		Select Absolutely not No Impartial Yes Absolutely
Home maintenance		Select Absolutely not No Impartial Yes Absolutely
Library		Select Absolutely not No Impartial Yes Absolutely
Bookshop		Select Absolutely not No Impartial Yes Absolutely
Childcare / support		Select Absolutely not No Impartial Yes Absolutely
Financial planning		Select Absolutely not No Impartial Yes Absolutely
Second hand goods		Select Absolutely not No Impartial Yes Absolutely
Salvage yard		Select Absolutely not No Impartial Yes Absolutely
Bus service		Select Absolutely not No Impartial Yes Absolutely
LETS		Select Absolutely not No Impartial Yes Absolutely

Is there anything else you would see as essential for you to move into the ecovillage?    

Any additional feedback, comments or thoughts: