Social Capital Survey Form for Az Single Scene,

Zip/Postal code
E-mail

1. Do you watch TV less than 4 hours per week?
Yes No
2. Do you get your news mostly from newspapers?
 Yes No
3. Do you attend regular meetings of 2 or more (non job-related) groups? Yes No
4. Do you live in a smaller town (less than 50,000)?
 Yes No
5. Do you vote regularly?
 Yes No
6. Do you have more than 3 close friends?
 Yes No
7. Do you tend to trust people rather than think that you just can't be too careful? Yes No
8. Is your round trip commute time less than 30 minutes per day?
 Yes No
9. Do you belong to a church/synagogue/mosque?
 Yes No
10. Have you had a social gathering in your home in the last month?
 Yes No
11. Do you know the first names of your direct neighbors?
 Yes No
12. Have you written a letter to the editor or a letter to a public
representative in the last year?
 Yes No

 



Az Single Scene