The
primary reader of this publication will be:
Mother
Father
Grandparent
Other
Number
of Children/Grandchildren:
1
2
3
4
5+
Age
of Children:
Infant to 5 yrs
6-10 yrs
11-15 yrs
16-20 yrs
Household
Information:
Rent Home
Own Home
Rent Apartment/Condo
Employment
Status:
Full Time
Part Time
Retired
At Home Parent
Age:
18-29
30-39
40-49
50-59
60+
|
Household
Income:
Under $25,000
$26,000-$40,000
$41,000-$60,000
$61,000-$80,000
$81,000 and Over
Do
you intend to share this Guide
with anyone else?
Yes - How many?
No
Level
of Education:
High School
Some College
College Graduate
How
did you hear about the Guide?
Please
choose the areas that are most
important to you:
Health & Medical
Volunteer Opportunities
Child and Family Safety
Toll Free Numbers
City and Gov't Numbers
Other:
Comments/Suggestions:
|
