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ThissurveyisdesignedtohelpTax Time improve our servicesoffered to the community andto reporton program participation. Any information you provide is private and your participation is completely voluntary. You can choose not to complete the survey and still receive free tax assistance.

*Please answer the questions on the back of this page*

  1. Last year, who prepared your taxes? Please choose 1.

*Please answer the questions on the back of this page*

This site

Another free tax site

Friend or family member

I did my own taxes

I used tax software

Paid tax preparer (H&R Block, Liberty Tax or Jackson Hewitt)

Car Dealer

I did not file a return

Other ______

*Please answer the questions on the back of this page*

  1. How didyoufirsthearaboutthis free tax preparation service?Pickupto3.

*Please answer the questions on the back of this page*

Radio ad

Friend or family member

An ad from a check cashing store

A flyer or poster

An ad delivered to my home

Social service agency

Child care center

Employer

College or University

Through 2-1-1

*Please answer the questions on the back of this page*

  1. Why didyouchoosethis tax preparation service?Pickupto3.

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I came here last year

It is close to home

Taxes are hard to do

I paid too much in the past

I trust the preparers

It is free

I already come to this location for other reasons

Other ______

*Please answer the questions on the back of this page*

  1. Howdoyouplantouseyourtax refund?Pickupto3.

*Please answer the questions on the back of this page*

Utility bills

Medical expenses/bills

Debt/credit card bills

Childcare

Groceries

Clothing

Mortgage or rent

Purchase a new home

New car or car repair

Savings

Education

Vacation

I don’t expect a refund

Other ______

*Please answer the questions on the back of this page*

  1. Which of the following statements best describe you? Please choose 1.

*Please answer the questions on the next page*

I only have a checking account

I only have a savings account

I have bothchecking and savings accounts

I do not have a bank account

I don’t want a bank account

*Please answer the questions on the next page*

  1. What are you currently saving for, or what would like to be able to save for? Pick up to 3.

*Please answer the questions on the next page*

A house

A new car or car repairs

New TV, phone, or other electronic

Education for myself or a family member

Savings for emergency purposes

A vacation

Retirement

Other ______

*Please answer the questions on the next page*

  1. Do you face any of the following challenges saving money? Pick up to 3.

*Please answer the questions on the next page*

I am able to save without too much difficulty

No bank account

Not enough income

Too much debt

Bills are too high

Unsure of how to save

Other ______

*Please answer the questions on the next page*

  1. Which of the following did you do last year? Pickallthatapply.

*Please answer the questions on the next page*

Used a credit card

Used a prepaid debit card

Used a money order

Wired money

Used a check cashing store

Used a rent-to-own store

Used a pawn shop

Used a pay day loan

Used a car title loan

*Please answer the questions on the next page*

  1. Which statement best describes you? Please choose 1.

*Please answer the questions on the next page*

I own my house

I rent my house

I share a home with family members or friends

Other ______

*Please answer the questions on the next page*

  1. Gender:  MaleFemale
  1. Age:16-3031-4546-60  61+
  1. Home Zip Code:______
  1. Race/ Ethnicity:

African American/ Black

Asian/ Pacific Islander

Caucasian

Hispanic or Latino/a

Native American

Other ______

  1. What is the highest level of education you have completed?

Less than high school

High school or GED

Some college

2-year college degree

4-year college degree

Master’s, doctoral or professional degree

  1. What do you do for a living? Choose all that apply.

Administrative work

Construction/ Labor

Retail

Sales

Business/ Financial Services

Healthcare

Education

Government/ Public Sector

Retired

Unemployed

Student

Other ______

  1. Annual Household Income:

0 - $9,999

$10 -$19,999

$20 – $29,999

$30 - $39,999

$40 - $49,999

$50,000+