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* 1. Would you like assistance with job search or employment placement?

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* 2. Are you interested in enrolling in career training classes?

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* 3. Are you over 65 and need assistance with daily living activities such as meals, laundry and housekeeping?

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* 4. Do you have anyone in your household between the ages of 16 and 24 who dropped out of high school at any time?

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* 5. If you are under the age of 64 and receiving SSI or SSDI benefits, are you interested in going to work?

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* 6. If you have school-age children in your household, what school(s) do they attend?

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* 7. Do you have children in your household that are under the age of 5?

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* 8. Are you interested in owning your own home?

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* 9. Is anyone in your household receiving support services such as tutoring, mentoring, counseling, anger management, trauma support services, etc.?

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* 10. If you are interested in receiving updates from the Office of Resident Services via email or text message, please include your email address and cell phone number in the box below.

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* 11. Do you have internet access in your home?

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* 12. Do you have a working computer device in your home (such as desktop computer, laptop or tablet)?

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* 13. Would you be interested in computer literacy classes?

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* 14. Please select your age group

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* 15. Tell us where you live.

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* 16. What is your address?

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