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* 1. What is your email address?

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* 2. First and Last Name

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* 3. What COUNTY do you live in?

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* 4. What city do you live in?

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* 5. What is your age?

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* 6. What is your gender?

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* 7. Do you have a high school diploma or GED?

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* 8. Have you earned a post-secondary credential/certificate?

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* 9. Are you currently enrolled in a post-secondary educational program?

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* 10. Are you currently employed?

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* 11. If employed, what is your status?

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* 12. At what age did you leave state's care (including independent living)?

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* 13. Do you have a full driver's license?

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* 14. Do you own a vehicle?

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* 15. Are you currently parenting or expecting a child?

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* 16. Why is your FUP/FYI Assistance Ending?

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* 17. Do you plan to remain in the same housing unit?

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* 18. Do you feel adequately prepared to meet your basic needs?

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