Household Information Questions

Having trouble paying rent or mortgage

Overcrowding — more than two people living in the same bedroom or multiple families living in one residence

Moving frequently — moving three or more times in one year • Staying with relatives

Spending the bulk of household income on housing — spending more than 30% of your income on housing

Experiencing an eviction

Experiencing a foreclosure

Homelessness — lacking a regular nighttime residence or having a primary residence that is a temporary shelter or another place not designed for sleeping

None of the above

Please complete the following questions. All information is confidential.

Please answer yes or no.

In the last 12 months, has your family experienced any of the following related to food? Please select all that apply.

Wayne Township Adult Education Portal