7. Financial Status

TYPE of INCOME Before Attending
ABLE Program		 While Attending
ABLE Program		 After Leaving
ABLE Program
Self Employed      
Salaried      
Unemployment Comp Disability      
Unemployment Comp Laid Off      
SSI/SSD      
Public Assistance      
Food Stamps      
Support      
SS Retirement      
Private Retirement      
       
       
       

  Own Lease Monthly Payment  
Residence 1        
Residence 2        
Car 1        
Car 2        
Computer        
         

What group would you consider yourself to fall into?

box icon Homeless
box iconPoverty
box iconLow Income
box iconMiddle class
box iconUpper middle
box iconWealthy

Adult Learner Code:_________ Interviewer’s Initials: ______ Interview Date______

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