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* 1. Have you experienced a hardship in 2022?

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* 2. Are you currently employed?

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* 3. Please provide your zip code in Georgia?

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* 4. Do you rent a home or an apartment?

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* 5. Is the place you need assistance with your primary residence?

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* 6. What is the total number of people who reside in this household?

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* 7. Have you or individuals in your household qualified for unemployment benefits?

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* 8. Are you or members or your household experiencing homelessness or housing instability?

If so, have you experienced the following?

*Has received a rental eviction notice.
*Has received past due utility or rent notice(s).
*Experiencing a housing cost burden.
*Forgoing or delaying the purchase of food, prescription meds, childcare, or similar essential necessities.

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* 9. What type of assistance are you requesting?

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* 10. What is your name, email, and phone number?

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