What is your age?
What is your citizenship status in the US?
What U.S. State or territory do you live in?
District of Columbia
Federated States of Micronesia
Gulf of Mexico
Northern Mariana Islands
Republic of Palau
What is your race/ethnicity?
What is your current employment status?
Describe your current and past professional experiences.(check all that apply)
Are you a current or prospective student?
What is your current marital status?
Are you a parent or primary caregiver?
How many people live in your household?
Are any of the following family members deceased (child, parent, spouse)?
Are you the spouse or surviving dependent of a veteran(alive or deceased)?
Are you, your spouse, parents or children currently receiving or are you eligible to receive benefits from any of the following programs? (check all that apply)
Are you or any of your family/household members suffering from an injury or illness?
Do you need medical advice or guidance for any of the following?(check all that apply)
Indicate if you or any of your family/household members have a disability.
What is your household's annual income before taxes?
How would you characterize your income?
Do you need Federal income tax information and return preparation assistance?
Do you have debt in any of the following areas?(check all that apply)
What describes your current housing / living situation?(check all that apply)
Are you in need of assistance or guidance regarding any of the following?(check all that apply)
Do you speak English fluently?