WHAT WOULD YOU DO WITH AN EXTRA $100 A MONTH?
HAPCAP is going to Washington, D.C. this March and we want to hear from you. This voluntary and confidential survey is intended to gather responses to advocate for the people we serve. There is no monetary compensation for filling out this survey. You may write on the back if needed. For questions, call Claire Gysegem, Public Relations Manager at (740) 767-4500 or email
What would you do with an extra $100 a month?
Can we use your response in our outreach materials? (No name or identifying information will be used)
If needed, would you ever be willing to speak with a member of the press?
If needed, would you ever be willing to speak with an elected official?
If yes to the previous two questions, please provide your name, county of residence, age, and best way to contact you in the field below.
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This form was created inside of Hocking Athens Perry Community Action.