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What is your age?
   
 
 
 
How long have you been at your current residence? (Months or Years)
   
 
 
 
Are you employed?
 
Yes
 
No (If answered NO, skip to question #6)

 
 
 
What is your occupation?
   
 
 
 
How long you been working in your present occupation?
   
 
 
 
In your community, do know the police or patrolmen?
 
Yes
 
No

 
 
 
In your community,have you ever came in contact with the police?
 
Yes
 
No

 
 
 
In your community, what this contact by the Police due to breaking some type of law?
*Your reply is strictly confidential*
 
Yes
 
No

 
 
 
In your community, what this contact with the police just a friendly conversation?
 
Yes
 
No
 
 
 
How did the police assist you in your situation?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
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