As a result of this program, have you changed your financial behavior? Yes No □ □ As a result of this program, have you tried to obtain more sleep? Yes No □ □ As a result of this program, have you made time for you? Yes No □ □ Gender: Male Female □ □ Age in years: 0-18 45-54 75-84 □ □ □ 19-34 55-64 85+ □ □ □ 35-44 65-74 □ □ Are you a Baby Boomer (born between 1946-1964)? Yes No □ □ Are you of Hispanic, Latino, or Spanish descent? Yes No □ □ Which of the following best describes you? White Asian □ □ Black/African American Hawaiian/Pacific Islander □ □ American Indian/Alaska Native Two or more mixed race/color □ □ 18. State where I live _______________________________________________ 19. County in which I reside _________________________________________ Additional Comments:
As a result of this program, have you changed your financial behavior? □ Yes □ No As a result of this program, have you tried to obtain more sleep? □ Yes □ No As a result of this program, have you made time for you? □ Yes □ No Gender: □ Male □ Female Age in years: □ 0-18 □ 19-34 □ 35-44 □ 45-54 □ 55-64 □ 65-74 □ 75-84 □ 85+ Are you a Baby Boomer (born between 1946-1964)? □ Yes □ No Are you of Hispanic, Latino, or Spanish descent? □ Yes □ No Which of the following best describes you? □ White □ Black/African American □ American Indian/Alaska Native □ Asian □ Hawaiian/Pacific Islander □ Two or more mixed race/color 18. State where I live _______________________________________________ 19. County in which I reside _________________________________________ Additional Comments: