New Client Survey

Tailored for Success, Inc. - New Client Survey

Thank you for taking the time to complete this survey. All information collected will be kept confidential and is only used as part of general demographical information sent to funders.

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* 1. First and Last Name:

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* 2. Email

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* 3. Full Mailing Address

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* 4. Age

18-25

25-35

35-55

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* 5. Ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 6. Household income

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

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* 7. Gender

Male

Female

Transgender

Other

Prefer Not to Answer

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* 8. Employment Status

Unemployed

Employed Part-time

Student

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* 9. Were you referred by an agency?

Yes

New Client Survey

Tailored for Success, Inc. - New Client Survey

Question Title

* 1. First and Last Name:

Question Title

* 2. Email

Question Title

* 3. Full Mailing Address

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* 4. Age

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* 5. Ethnicity

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* 6. Household income

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* 7. Gender

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* 8. Employment Status

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* 9. Were you referred by an agency?

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* 10. If answer to Question 8 is yes, please indicate agency.