Laundry Love Fort Worth - Identification Form

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To serve you, we at LLFW need to collect some basic information. The aggregated data help us fundraise
We keep all collected info in strict privacy and do not release identifying information, ever, to anyone

What's your name? Please provide first and last. *

Contact phone number *

Contact email *

Number of adult in household *

Number of children in household. If none, give 0 *

Are you employed? *

Yes

No, retired/disabled

No, actively seeking

If you're currently employed, what's your wage range?

Less than $10k/year or minimum wage ($7.25/hour)

Less than $20k/year or wage less than $10/hour

Less than $30k/year or wage less than $15/hour

Other:

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Are you on food stamp? *

Yes

Are you eligible for the free lunch program? *

Yes

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