This form will be used by the Center for Guaranteed Income Research to randomly select program participants for Project Resilience. One hundred participants will receive $500 per month for one year. One hundred others will not receive the $500, but will be invited to participate in research activities. If you are selected into either of those groups, you will receive an invitation to complete a longer survey from the Center for Guaranteed Income research after March 15th. Then, you will be notified which group you are in. Note: if you completed the longer survey previously, your name has been saved and you do not need to complete this form again.