Anchorage CoC 2023 Unsheltered Street Count Survey

This form is to be completed with clients on January 31st, February 1st, and 2nd to ask where they slept on the night of January 30th, 2023. Questions that are not answered will not be “interpreted”. Include notes if necessary but answer all required questions to the best of your ability.

Informed Consent Statement

(Read to Each Respondent)

We are conducting a community-wide survey related to the characteristics of people and their housing.

  • Participation is completely voluntary.
  • If you don’t want to take the survey, you don’t have to answer any questions.
  • If you do take the survey, you can stop, you can change your mind, or you can skip questions.
  • Doing the survey or not doing the survey won’t change what benefits you qualify for.
  • We will keep your participation in this survey confidential.
  • The agency responsible for the Point in Time count will make reports from the surveys.
  • The surveys don’t get shared and are later deleted.
  • The reports are used for planning and do not include names.
  • If you agree to participate, I will read the questions to you, and I will record your answers.

Survey Questions