Bridge Fridge - Survey
Help Us, Continue to Help You.
This survey allows us to seek grant opportunities and to continue on our mission to build a healthier community. Please take the survey.
1.
Where is your principal residence
Southbridge, MA
Dudley, MA
Webster, MA
Charlton, MA
Sturbridge, MA
Holland, MA
Other
2.
How many persons are in your household?
1
2
3
4
5 or more
3.
Are you a single-parent head of household with dependent minor children living with you?
Yes
No
4.
If you responded "yes" to question 3, please specify your gender.
Male
Female
Nonbinary
5.
Is anyone in your household disabled or handicapped?
Yes
No
6.
If you answered "yes" to question 5, how many individuals are disabled or handicapped?
1
2
3
4 or more
7.
Which of the following categories most nearly approximates the annual household income in the home where you currently reside?
1 Person: $0 - $20,650
1 Person: $20,651 - $34,400
1 Person: $34,401 - $54,950
1 Person: over $54,950
2 Person: $0 - $23,600
2 Person: $23,601 - $39,300
2 Person: $39,301 - $62,800
2 Person: over $62,800
3 Person: $0 - $26,550
3 Person: $26,551 - $44,200
3 Person: $44,201 - $70,650
3 Person: over $70,650
4 Persons: $0 - $29,450
4 Persons: $29,451 – $49,100
4 Persons: $49,101 – $78,500
4 Persons: over $78,500
5 Persons: $0 - $31,850
5 Persons: $31,851 – $53,050
5 Persons: $53,051 – $84,800
5 Persons: over $84,800
6 Persons: $0 - $35,160
6 Persons: $35,161 – $57,000
6 Persons: $57,001 – $91,100
6 Persons: over $91,100
7 Persons: $0 - $39,640
7 Persons: $39,641 – $60,900
7 Persons: $60,901 – $97,350
7 Persons: over $97,350
8 Persons: $0 - $44,120
8 Persons: $44,121 – $64,850
8 Persons: $64,851 – $103,650
8 Persons: over $103,650
8.
What race do you and your family identify with:
White
Black/African American
Asian
American Indian/Alaska Native
Native Hawaiian/other Pacific Islander
American Indian/Alaska Native and White
American Indian/Alaska Native and Black/African American
Other Race(s)
Other (please specify)
9.
Hispanic/Latino (Total number of persons of any race(s))
10.
Elderly (Total number of persons age 60 or over)
