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This survey is for SC homeowners struggling to stay in their homes. We will use your answers to help us design the best relief program we can. It is completely anonymous and your answers will NOT affect whether you receive assistance.

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* 1. Mark any of the following that you owe or are behind on:

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* 2. How many months are you behind on your mortgage payments? (skip if none)

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* 3. About how much (in dollars) is your monthly mortgage payment?

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* 4. If your past-due bills were paid, would you be able to afford them going forward?

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* 5. Are you currently employed?

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* 6. Do you receive any form of government assistance other than unemployment (such as TANF, SNAP, Medicaid, etc)?

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* 7. If you would like to be contacted when the program opens for applications, please include your email:

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