Thirteen's 13 Families Submission Form
How many people in your family?*
What is your current employment status?*
What is your household income?*
Do you consent to have your information shared with our partners for the purpose of this program?*
Confidentiality Statement: Your privacy is important to us. The information you provide in this survey will be kept strictly confidential and will only be used for the purpose of assessing needs. We will not share your personal information with any third parties without your consent. All responses will be anonymized in any reports or publications. Thank you for your participation and helping us serve our community better.
