Anonymous Survey Please note - This is an ANONYMOUS 2 question survey used specifically for grant reporting requirements You will NOT be asked to indicate any identifying information on this form. This form and the information completed here will be processed and kept separated from the other required forms completed to admit you to the men's program1. Please choose your family size*--12345678 or moreMy family size is 1 and my income is below $24,980 my income is above $24,980 My family size is 2 and* my income is below $33,820 my income is above $33,820 My family size is 3 and* my income is below $42,660 my income is above $42,660 My family size is 4 and* my income is below $51,500 my income is above $51,500 My family size is 5 and* my income is below $60,340 my income is above $60,340 My family size is 6 and* my income is below $69,180 my income is above $69,180 My family size is 7 and* my income is below $78,020 my income is above $78,020 My family size is 8 and* my income is below $86,860 my income is above $86,860 2. Do you receive social security or disability benefits? Yes No Thank you! Your participation is truly appreciated. DAIP Staff 2013 518B.02, subd. 2(f)
