LOVE NOW Programs Grant & Scholarship Screening Survey

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1. CONTACT INFORMATION: we promise not to advertise to you without permission. If you qualify we will need to send you materials.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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2. How Old are you?

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3. Have you been a Vermont Resident for at least one year.

Yes

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4. Do you have a high school diploma or GED

Yes

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5. Are you currently enrolled in any higher degree programs.

Yes

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6. ARE YOU IN DEFAULT ON ANY STUDENT LOANS?

Yes

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7. What is your total 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

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8. Did you file taxes in 2025?

Yes

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9. If YES you filed taxes in 2025, how much income did you report on your tax return?

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

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10. If you did not file taxes in 2025 please explain why?

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11. Do you have dependents that you claim on your taxes?

Yes

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12. If you have people you claim on your taxes please list how many.

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13. Do you have access to WIFI?

Yes

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14. DO YOU HAVE ACCESS TO A COMPUTER OR UPDATED PHONE DEVICE

Yes

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15. If you DO NOT have access to wifi, or technology are you willing to get what is needed to participate in this online program?

Yes

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16. Are you willing to commit to participating in 8 months of weekly training and coaching? recordings are available, but 75% attendance is required.

Yes

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17. Tell me your story! What brought you here and why do you want this?

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18. Do you have any health challenges? If so, please explain what they are?

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19. Tell me about your finances? Is advancing in employment or starting a business a goal?

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20. Tell me a little about how you are feeling inside right now - heavy or light?

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21. WHAT PART OF YOU LIFE DO YOU WANT THE MOST HELP WITH

Your health

Your finances

Your wellness

Your relationships

Your job

all of the above

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22. Is there anything else you want to ask me, or tell me about.

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23. BEFORE YOU GO I want to tell you three things.

You are worthy of this!

Your can do this!

We are here to be with you while you do this!

I will be in touch with you soon to talk about your next steps - don't forget to join the LOVE NOW Guest Room Facebook group.

LOVE NOW Programs Grant & Scholarship Screening Survey

Question Title

* 1. CONTACT INFORMATION: we promise not to advertise to you without permission. If you qualify we will need to send you materials.

Question Title

* 2. How Old are you?

Question Title

* 3. Have you been a Vermont Resident for at least one year.

Question Title

* 4. Do you have a high school diploma or GED

Question Title

* 5. Are you currently enrolled in any higher degree programs.

Question Title

* 6. ARE YOU IN DEFAULT ON ANY STUDENT LOANS?

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* 7. What is your total household income?

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* 8. Did you file taxes in 2025?

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* 9. If YES you filed taxes in 2025, how much income did you report on your tax return?

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* 10. If you did not file taxes in 2025 please explain why?

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* 11. Do you have dependents that you claim on your taxes?

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* 12. If you have people you claim on your taxes please list how many.

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* 13. Do you have access to WIFI?

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* 14. DO YOU HAVE ACCESS TO A COMPUTER OR UPDATED PHONE DEVICE

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* 15. If you DO NOT have access to wifi, or technology are you willing to get what is needed to participate in this online program?

Question Title

* 16. Are you willing to commit to participating in 8 months of weekly training and coaching? recordings are available, but 75% attendance is required.

Question Title

* 17. Tell me your story! What brought you here and why do you want this?

Question Title

* 18. Do you have any health challenges? If so, please explain what they are?

Question Title

* 19. Tell me about your finances? Is advancing in employment or starting a business a goal?

Question Title

* 20. Tell me a little about how you are feeling inside right now - heavy or light?

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* 21. WHAT PART OF YOU LIFE DO YOU WANT THE MOST HELP WITH

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* 22. Is there anything else you want to ask me, or tell me about.

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* 23. BEFORE YOU GO I want to tell you three things.

1. CONTACT INFORMATION: we promise not to advertise to you without permission. If you qualify we will need to send you materials.

2. How Old are you?

3. Have you been a Vermont Resident for at least one year.

4. Do you have a high school diploma or GED

5. Are you currently enrolled in any higher degree programs.

6. ARE YOU IN DEFAULT ON ANY STUDENT LOANS?

7. What is your total household income?

8. Did you file taxes in 2025?

9. If YES you filed taxes in 2025, how much income did you report on your tax return?

10. If you did not file taxes in 2025 please explain why?

11. Do you have dependents that you claim on your taxes?

12. If you have people you claim on your taxes please list how many.

13. Do you have access to WIFI?

14. DO YOU HAVE ACCESS TO A COMPUTER OR UPDATED PHONE DEVICE

15. If you DO NOT have access to wifi, or technology are you willing to get what is needed to participate in this online program?

16. Are you willing to commit to participating in 8 months of weekly training and coaching? recordings are available, but 75% attendance is required.

17. Tell me your story! What brought you here and why do you want this?

18. Do you have any health challenges? If so, please explain what they are?

19. Tell me about your finances? Is advancing in employment or starting a business a goal?

20. Tell me a little about how you are feeling inside right now - heavy or light?

21. WHAT PART OF YOU LIFE DO YOU WANT THE MOST HELP WITH

22. Is there anything else you want to ask me, or tell me about.

23. BEFORE YOU GO I want to tell you three things.