Southern Rural Black Women's Initiative

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TELL US ABOUT THE QUALITY OF YOUR LIFE AS A BLACK WOMAN IN THE SOUTH
Take Our Survey

Quality of Life Survey

Institute for Women and Work
Quality of Life Index

How’s your quality of life? One way to find out is by completing the Institute for Women and Work’s Quality of Life Survey.

The index provides quality of life measures for 11 major categories: Culture, Recreation, and Community Life; Economic Security and Work; Education; Environment; Family Life; Government and Politics; Health; Housing; Human Rights; Personal and Public Safety; and Transportation.

The Institute plans to conduct this survey annually and track the findings from year to year. The results will help us determine whether quality life is improving, deteriorating, or staying the same.

Thank you in advance for your participation.

Instructions
Please rank the items below using the following scale:

1 = very dissatisfied
2 = dissatisfied
3 = indifferent
4 = satisfied
5 = very satisfied
NA = not applicable


Culture, Recreation, and Community Life
How satisfied are you with:
Opportunities to attend/participate in cultural activities and events in your community:
Opportunities to take part in recreational activities in your community:
Opportunities for civic and community involvement:
The overall quality of the relationships between various groups (racial, religious, or other) in your community:

Economic Security and Work
How satisfied are you with:
The type of work you do – how interesting, enjoyable, and/or fulfilling it is:
Your salary:
Your job-related benefits (e.g., health care, paid sick days and holidays, paid family leave, etc.):
The security of your job:
The physical safety of your job and workplace:
Opportunities for advancement at your workplace:
Relationships between co-workers at your workplace:
Relationships between labor and management at your workplace:
Your rights on the job (including the right to organize, to have some say in how your work is done, what hours you work, etc.):
The degree to which your job enables you to strike a balance between work and other life responsibilities (e.g., family, education, community involvement, etc.):
Your ability to obtain low- or moderate-interest loans and credit (e.g., to buy a home, start a business, or pay for school):
Your ability to afford essential goods (e.g., clothing, shelter, food, utilities):
Your ability to afford nonessential goods (travel, recreation, cultural events, etc.):
The degree of economic security you will have when you retire:
Your overall economic well-being:

Education
How satisfied are you with:
The accessibility of preschool education in your community:
The affordability of preschool education in your community:
The quality of preschool education in your community:
The quality of elementary and secondary education (grades K through 12) in your community:
The accessibility of post-secondary education (i.e., college education) in your community:
The affordability of post-secondary education in your community:
The quality of post-secondary education in your community:

Environment
How satisfied are you with:
The air quality in your community:
The water quality in your community:
The availability of public open spaces in your community:
The overall availability of space and lack of crowding in your community:
The natural beauty of the environment you live in:
The man-made beauty of the environment you live in:
The general environmental safety and healthfulness of your community (e.g., lack environmental waste, toxins, hazardous materials, etc.):

Family Life
How satisfied are you with:
The accessibility of child care in your community:
The affordability of child care in your community:
The quality of child care in your community:
The accessibility of care for the elderly in your community:
The affordability of care for the elderly in your community:
The quality of care for the elderly in your community:
The amount of time you spend with your family:
The quality of the time your spend with your family:

Government and Politics
How satisfied are you with:
Your local elected officials:
Your state elected officials:
Your national elected officials:

Health
How satisfied are you with:
The accessibility of your health care:
The affordability of your health care:
The quality of your health care:
The quality of the nutrition you are able to receive:

Housing
How satisfied are you with:
The accessibility of housing in your community:
The affordability of housing in your community:
The overall quality of your housing :

Human Rights
How satisfied are you with:
The progress that has been made in your community toward eliminating discrimination on the basis of sex:
The progress that has been made in your community toward eliminating discrimination on the basis of race and ethnicity:
The progress that has been made in your community toward eliminating discrimination on the basis of religious affiliation:
The progress that has been made in your community toward eliminating discrimination on the basis of sexual orientation:
The progress that has been made in your community toward eliminating discrimination against people with disabilities:
The civil liberties (including freedom of speech, freedom of the press, the right to a fair trial, etc.) that residents of your community enjoy:
The religious liberty (freedom of worship) that residents of your community enjoy:
The political liberties that residents of your community enjoy (including the right to assemble, the right to petition, the right to vote, and the right to dissent):
The economic well-being that residents of your community enjoy:

Personal and Public Safety
How satisfied are you with:
The rate of violent crime in your community:
The rate of nonviolent crime in your community:
Your physical safety in your community:
Your physical safety in your country in general:

Transportation
How satisfied are you with:
The accessibility of the transportation you use:
The affordability of the transportation you use:
The timeliness and reliability of the transportation you use:
The safety of the transportation you use:

Tell Us About You
Name:
Address:
City:
County:
State:
Zip:
Phone:
Email: