New Applicant Survey Question Title * 1. Would you like assistance with job search or employment placement? YES NO Question Title * 2. Are you interested in enrolling in career training classes? Yes No Question Title * 3. Are you over 65 and need assistance with daily living activities such as meals, laundry and housekeeping? Yes No Question Title * 4. Do you have anyone in your household between the ages of 16 and 24 who dropped out of high school at any time? Yes No Question Title * 5. If you are under the age of 64 and receiving SSI or SSDI benefits, are you interested in going to work? NO, I am not receiving SSI/SSDI benefits YES, I am receiving SSI/SSDI benefits and would like to go to work NO, I am not interested in going to work while receiving my SSI/SSDI benefits Done