SNAP QUESTIONNAIRE
The Supplemental Nutrition Assistance Program (SNAP) is a federal program that helps families put food on the table. Across the United States there are families with children on SNAP. It is the largest program working to fight hunger in America.

El Programa de Asistencia Nutricional Suplementaria (SNAP) es un programa federal que ayuda a las familias a poner comida en la mesa. En todo Estados Unidos, hay familias con niños que reciben SNAP. Es el programa más grande que trabaja para combatir el hambre en Estados Unidos.
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Name *
Phone Number *
Email *
Race (choose one) / (Raza (marque uno) *
Required
Ethnicity (choose all that apply) / Etnia (marque todo lo que corresponda) *
Spanish *
Citizenship Status (Estatuto de ciudadania) *
Number of years you have been in USA (número de años que ha estado en los EE. UU) *
 Number of household members (número de personas que viven contigo) *
Are you the Head of Household? (Es ud. jefa de hogar?) *
Does everyone living in the house purchase and prepare food together? (Todas las personas en la casa comprar y preparar comida juntos?) *
Are you elderly or disabled? Check all that apply (Es ud. anciano o discapacitado?  Marque todo lo que corresponda) *
Required
Do you currently receive SNAP benefits? (Recibe Ud. actualmente SNAP?) *
Does anyone in your household receive SNAP benefits? (Alguien en tu casa recibe actualmente SNAP?) *
Estimated household monthly income before taxes (ingreso familiar estimado por mes, antes de impuestos) *
Required
Employment Status (estatuto de empleo) *
Need help with SNAP application, reporting, or recertification? (Necesita ayuda para solicitar SNAP o recertificación?) *
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