Student Retired Disabled Other [describe] ________________________ Prefer not to respond What is your annual household income? ____ $0 1,000 – ____ $1,000 $3,000 – ____ $3,000 6,000 – ____ $6,000 $9,000 – ____ $9,000 $12,000 – ____ $12,000 $15,000 – ___ $15,000+
Student Retired Disabled Other [describe] ________________________ Prefer not to respond What is your annual household income? ____ $0 – 1,000 ____ $1,000 – $3,000 ____ $3,000 – 6,000 ____ $6,000 – $9,000 ____ $9,000 – $12,000 ____ $12,000 – $15,000 ___ $15,000+
navajo_home_heating_survey_template_1.docx