Eviction Prevention Clinic Questionnaire

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* 1. Are You a Tenant or Landlord? What Is Your Level of Education?

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* 2. Primary Race/Tribal Affiliation

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* 3. What is Your Spoken Language

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* 4. Within the Last 30 days, Have You Received  Any Income?

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* 5. What is Your Household Income?

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* 6. Do you currently receive Supplemental Security Income (SSI) benefits or any other benefits?

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* 7. What is your gender?

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* 8. What is your age?

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* 9. Which of the following categories best describes your employment status?

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* 10. What is Your Marital Status?

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