Help Us, Continue to Help You.

This survey allows us to seek grant opportunities and to continue on our mission to build a healthier community. Please take the survey.

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* 1. Where is your principal residence

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* 2. How many persons are in your household?

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* 3. Are you a single-parent head of household with dependent minor children living with you?

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* 4. If you responded "yes" to question 3, please specify your gender.

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* 5. Is anyone in your household disabled or handicapped?

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* 6. If you answered "yes" to question 5, how many individuals are disabled or handicapped?

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* 7. Which of the following categories most nearly approximates the annual household income in the home where you currently reside?

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* 8. What race do you and your family identify with:

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* 9. Hispanic/Latino (Total number of persons of any race(s))

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* 10. Elderly (Total number of persons age 60 or over)

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