Apply to participate in a research study on public benefits

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We will use this survey to see if you are a good fit for our study. If you qualify, we will contact you to set up a time for the interview. For participating in the 1 hour study, you will receive a $50 Visa gift card.

Requirements:
- 18+ years old
- Illinois resident
- You participate in one or more of the following programs: Medicaid, Food Stamps (SNAP), WIC, LIHEAP, TANF
- You can meet in person for an hour on Thursday, August 22 sometime between 9am-12pm

You can read more about Code for America here: https://www.codeforamerica.org/about-us

Name

Phone Number

Email Address

Which programs do you participate in (select all that apply)?

Medicaid

Food Stamps (SNAP)

WIC (Women, Infants, and Children)

TANF (Temporary Assistance for Needy Families)

LIHEAP (Low Income Home Energy Assistance Program / Utility Bill Assistance)

Other:

When are you available to meet in person (check all that apply)?

Meeting place will be near Union Square Park in Springfield

Thurs, August 22 (9am-10am)

Thurs, August 22 (10am-11am)

Thurs, August 22 (11am-12pm)

None of the above

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