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* 1. Zip Code?

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* 2. Household Size

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* 3. How many children live in the home? (under 18)

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* 4. How many senior citizens live in the home? (60+)

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* 5. Age of Person Taking Survey

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* 6. Highest Education Completed

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* 7. Current employment status?

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* 8. In the last 6 months, has your income increased, decreased or stayed the same?

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* 9. How frequently do you worry about not having enough food to eat?

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* 10. What are your primary needs at this time?

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* 11. Why did you choose to receive services from SSCH?

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* 12. Are you satisfied with SSCH services?

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* 13. Enter for a chance to win a $25.00 Kroger gift card!

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