Some information about you:

First name:
Surname:
email address:	*
Country:
State:
Postcode:
Occupation:
Current housing:	Home owner Renting
Your age:	Under 18 18-25 26-30 31-35 36-40 40-45 46-50 51-55 56-60 61-65 66-70 71-80 81-90 91-100 100+
Planning to move?:	Yes No Considering Could be tempted
Number of children:	expecting 0 1 2 3 4 5 6+
Age of eldest child:	N/A O to 12 mnths 1-2 years 2-3 years 3-4 years 4-5 years 5-6 years 6-7 years 7-8 years 8-9 years 10+ years
How did you find out about us?

How would you rate your understanding of what an ecovillage is?

Please Select Excellent Average Limited No idea ..Why? 

Why are you filling in this questionnaire on ecovillages? Tick the ones that apply to you.

Would like to live in one	Would like to learn more	Like to have input
Interested for the future	Have had previous experience	Sounds interesting
Other -    Please give details:

Please tick the statements below which you agree with:

I believe strong community is vital for a high quality of life
I am interested in alternative building methods
I plan to work from home as much as possible
I would like to/or have a home based business 
I am interested in the concept of Permaculture
I am interested in chemical free food
I believe that responsible waste management is important
I would like to use alternative energy sources
I would like something different from a normal suburban block
I would like to have a say in the area surrounding my own block
Children benefit from a connection with a natural environment 

Now imagine/pretend/dream that you have decided to buy a block in an ecovillage. You have the opportunity to determine exactly what you would want. Select you preferences for the items below:

Preferred overall ecovillage size  (Includes common property area)	Please Select! 50 acres 100 acres 200 acres 300 acres plus Any
Preferred own block size	Please Select! 250 sqm 500 sqm 750 sqm 0.25 acre 0.5 acre 0.75 acre 1 acre 1 acre plus Any
Price you would be prepared to pay for your own individual titled block	Please Select! Up to $20,000 Up to $30,000 Up to $40,000 Up to $60,000 Up to $80,000 Up to $100,000
How would you fund the purchase of your block	Please Select! own funds mortgage other loan Not decided
Maximum travel time from central Perth	Please Select! Up to 20 min Up to 30 min Up to 40 min Up to 50 min Up to 60 min Any
Should dogs and cats be allowed	Please Select! Yes No Dogs -no cats Cats -no dogs

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

Select the type of services and facilities that you would like to see provided?

electricity	waste disposal	visitors accommod
water	community centre	village green
phone	cafe	school/ learning centre
internet access	community general store	regular forums
intranet	commercial area	leisure services
internal phone system	second hand goods area	bus service
LETS system	business area
Other -Please specify :

Now your chance to really have your say:               

1. What do you think of our ecovillage concept?

2. What would be the key factor for you to  live in an ecovillage?

3. Do you have any information, contacts, or know of any available land that you believe 
would be  relevant to this concept?

4. Having completed this questionnaire and read some of the additional information 
provided, would you seriously consider purchasing a block in our ecovillage? and Why?

  Any additional feedback, comments or thoughts: