Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. 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. OK Question Title * 1. First and Last Name: OK Question Title * 2. Email OK Question Title * 3. Full Mailing Address OK Question Title * 4. Age 18-25 25-35 35-55 OK Question Title * 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 OK Question Title * 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 OK Question Title * 7. Gender Male Female Transgender Other Prefer Not to Answer OK Question Title * 8. Employment Status Unemployed Employed Part-time Student OK Question Title * 9. Were you referred by an agency? Yes No OK Question Title * 10. If answer to Question 8 is yes, please indicate agency. OK SURVEY COMPLETED - THANK YOU!