* 1. In a few sentences, tell us what brought you to your current financial state?

* 2. What steps are you taking to get yourself out of your current financial hardship?

* 3. What is your monthly rent payment?

* 4. For which month do you need rent to be covered?

* 5. How many children do you have? How old are they?

* 6. If you receive child support, how much do you receive monthly? If you do not receive support, then please answer N/A.

* 7. Does ALUF have permission to share your story? This is not mandatory to receive assistance.

* 8. Please provide your first/last name, email and/or phone number to be contacted.

Note: Survey Monkey does not provide ALUF with these details.

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