Access and Awareness Survey

1. Age *This question is required.

2. Gender *This question is required.

3. Zip Code *This question is required.

4. How long have you lived in Berks County? (Number of Years) *This question is required.

5. Ethnic Origin *This question is required.

6. Household Composition - Number of members in your household

Under 18
Over 18

7. Household Income - past 12 months before tax *This question is required.

Tell us about yourself