COTS Survey administrator, circle to which room this survey informs:

• Chill Room
  
• Dining Hall
  
• Patio
  

1. Please rate what you feel is most important in this space, in order from 1 to 5

(1 = least important, 5 = most important):

• Room Colors
  
• Wall Art/Decorations
  
• Plants
  
• Lounging furniture
  
• Workspace furniture

2. Which of these choices best describes how you would like to use the space?

• School work
  
• Employment work
  
• Pleasure and game play
  
• Socializing with others
  
• Quiet, relaxing space
  
• A place to reflect
  
• Other (please specify):

3. In this space, what kind of materials would you prefer?

• Wood
  
• Stone
  
• Glass
  
• Leather
  
• Cork
  
• Paper
  
• Metal
  
• Ceramic
  
• Other (Please Specify):
  

4. What items would you be interested in placing in this space?

(check all that apply):

• Pillows
  
• Family Photos
  
• Framed personal/family artwork
  
• Framed professional artwork
  
• House plants
  
• Lamps
  
• Rugs
  
• Scented Items
  
• Tall (work) tables
  
• Short (coffee) tables
  
• Storage and Shelving
  
• Other (please specify):

5. Where do you find inspiration?

• Magazines
  
• TV
  
• Art & Music
  
• Sports
  
• Business
  
• Family & Friends
  
• COTS Staff
  
• Other (please specify):
  

6. How beneficial would this room be to you?

• Extremely useful
  
• Useful
  
• Somewhat useful
  
• Not very useful
  

7. In this space, what types of activities do you prefer?

• Games
  
• Quiet time
  
• Intimate Conversation
  
• Group Conversation
  
• Do-It-Yourself projects
  
• Personal development
  
• Arts and Crafts
  
• Draw/Paint
  
• Knit/Sew/Crochet
  
• Other (please specify)
  

8a. What is your gender?

• Female
  
• Male

8b. What s your age?

• Other
  
• Under 20
  
• 20-25
  
• 25-30
  
• 30-40
  
• 40-50
  
• 50 and older
  
• Under 20
  
• 20-25
  
• 25-30
  
• 30-40
  
• 40-50
  
• 50 and older

9. What is your resident status at COTS?

• Consumer
  
• Employee
  
• Volunteer
  
• Other (please specify)
  

10. Which of the following (pick one) best describes how the Peterboro building fulfills your housing needs?

• I love it! It’s just how I needed it
  
• It’s a little dated but it’ll do for now
  
• A work in progress
  
• A blank Slate
  
• Depressing. It needs some changes