So that we can plan and collaborate to help those in the community who are struggling to make rent and/or utility payments, we first need to understand the scope of the challenges. Your anonymous responses here will help us to do that. 

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* 1. If you are currently behind on rent payments, please complete the following:

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* 2. If you are currently behind on utility bill payments, please complete the following:

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* 3. What assistance, if any, have you received in the past six months to pay your rent and/or utility bills?

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* 4. What is your current employment status?

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* 5. What is your average monthly household income?

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* 6. How many people live in your household?

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* 7. When do you anticipate having enough income to cover your regular monthly rent and utility bills?

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* 8. Please add any additional information you think would be helpful for us to know about your situation.

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