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* 1. Contact Information - if no email, write n/a 

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* 2. Please check the one that best describes you:

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* 3. Please select the one that best describes you:

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* 4. What is your preferred language?

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* 5. Household Employment Information:

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* 6. Do you have any dependents ( children, foster children, step-children, etc)?

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* 7. Non City Residents: Town/Village

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* 8. Which of the following would you like to know more about? (Check ALL that apply)

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* 9. Would you like to join our email list? CASH will share information about program updates, community resources, and information about new services and tax workshops, etc.

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* 10. Would you like to be a CASH Volunteer? Volunteers are required to utilize an email account.

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* 11. How would you like to provide input on improving CASH Services?  

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* 12. Save Your Refund is a national project that encourages taxpayers to save at least $50 of their federal refund and enter for a chance to win $100. Are you interested in learning more?

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* 13. Roc Your Refund Program:
For Monroe County Residents with dependent(s): Would you like to commit to saving $200 in a US Savings Bond, receive a $25 Wegmans gift card for completing a survey, and have the chance to have your savings matched by up to 50%*?
*Not everyone will be chosen to receive a match, those selected will be chosen at random.

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* 14. ROC Your Family’s Future Project:
We are looking for taxpayers claiming the Earned Income Tax Credit for the FIRST time to participate in this project. Eligible participants are asked to complete a survey and will receive a $25 Wegmans gift card. Are you interested in learning more?

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