Multi-Unit Housing Technical Assistance Survey

Multi-Unit Housing Technical Assistance Survey

Name*

Job Title*

Property Name*

Mailing Address*

County*

Email Address*

Phone Number*

Preferred Method of Contact*

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Does your property have a smokefree policy?

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Number of Non-Residential Buildings

Number of Residential Buildings

Number of Units

Are any buildings dedicated smoke/tobacco free?

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Number of Employees (Full and Part Time)

I am Interested in the following:

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I would like more information on:

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Please Upload Your Tobacco Policy Here (optional)

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Send me a copy of my responses

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