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* 1. County you reside in:

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* 2. Are you familiar with NMCAA?

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* 3. What is your age?

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* 4. Type of household:

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* 5. Marital Status

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* 6. Number of People Living in Your Home

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* 7. How many hours per week do you work

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* 8. Is anyone in your household Active Duty Military?

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* 9. Is anyone in your household a US Veteran?

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* 10. Race: (check all that apply)

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* 11. Monthly Household Income:

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* 12. Highest Grade Level/Education you have completed:

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* 13. What sources of Income has your household had in the past year? (check all that apply)

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* 14. In the past year have you needed help applying for public benefits? (Social Security, SSDI, WIC, TANF, etc)

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