We greatly appreciate your help with our regional goal of encouraging people to call this place home. Collected input from Survey, Mosaic, Profile, and Attachments will be combined with data obtained from other sources. We hope to display the wonderful mosaic defined as Chemung and adjacent NY and PA counties in the near future.

Thank you for your assistance with our shared goals.

(An asterisk mean the field is required)

SURVEY

What does the word Community mean to you?

What is Home?

What pieces of the community mosaic should we celebrate to encourage people to call this place home?

What challenges hinder our efforts to encourage people to call this place home?

MOSAIC

Our hope is to define and evaluate the many components of our regional Mosaic. Please use the following section as an opportunity for you to highlight and promote an individual, entity, group, organization or location that you believe we should consider as a community Mosaic component.

Title

Detail

Mailing Address

City

State

Zip Code

Business / Organization

Entity Type

Phone Number

Email Address

Web Site Address

Social Media

Tag Words

PROFILE

Our hope is that we will be able to group and categorize responses. Please assist this process by completing the following Profile section.

First Name

Last Name

Prefix

Suffix or Nickname

Career Status

Age

Mailing Address

City

State

Zip Code

Home Phone

Cell Phone

Social Media

ATTACHMENTS

Optional JPG images or PDF documents may be attached to augment your survey input. Maximum combined size of all attachments is 5 Mb.”

Upload File #1 (JPG or PDF)

Section

Comments for Attachment 1

Upload File #2 (JPG or PDF)

Section

Comments for Attachment 2

Upload File #3 (JPG or PDF)

Section

Comments for Attachment 3

Please use my information for demographic purposes only.