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Please complete the short survey below to be eligible for future grants in 2021. If you have any problems or questions while completing this survey, please call us at (844) 737-5871.

**This survey must be completed by January 31st in order to be eligible for the PerkUp program in 2021.

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* 1. Please verify your personal information

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* 2. What is your race? (select all that apply)

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* 3. Are you of Hispanic or Latino origin (ethnically)?

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* 4. What is your marital status?

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* 5. Filing status on most recent tax return?

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* 6. Since you took the last survey, how has your employment situation changed?

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* 7. Since you took the last survey, has the employment situation changed for any other adult living in your home, such as a spouse or partner?

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