General survey for evacuee resettlement

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GENERAL SURVEY FOR BVACUEE


RESETTLEMENT


Inland Farm Cooperative


1530 Buchanan Street


San Francisco, California


1. HEAD OF FAMILY No. in Family


`Last "~ Tirst


2. ADDRESS


Route or Street No. City or Town


3. NAMES OF OTHERS IN FAMILY: AGE


M or FEMALE


4. Those over 18 years of age will give their qualifications and abilities


so that talents, special skills, experiences, and occupation can he


determined in the project.


`NAMES OCCUPATI ON


SPECIAL SKILLS__


TRAINING OR EDUCATION


High School College Major


ACTUAL EXPERIENCE : es


What type of work: No. of years


OTHER QUALIFICATIONS 4


oo


_ ASLM BQUIPMENT IN POSSESSION


C4 OTHER USEFUL EQUIPMENTS


* This survey will be used to determine the number of homes, hospitals,


schools, acreage of farms, and etc. that will be needed in this COOP


ERATIVE Project.


Kindly attach a sheet of paper in giving further information if


necessary, but be sure to prefix the correct number of the


question for each answer. Thank you.


* IMPORTANT; Notify above address of any change of your address or if


you have made other plans, let us know. (this is most im


portant for this survey to be effective.)


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