Birth – 2 years: Type a label 3 – 4 years: Type a label 5 – 12 years: Type a label 13 – 18 years: Type a label 19 – 54 years: Type a label 55+ years: Type a label Not applicable Type a label
Please state the race and ethnicity of the clients served by your agency (in percentages).African American/Black Type a label East Asian Type a label Hispanic or Latinx Type a label Middle Eastern Type a label Native American/Alaskan Native/First Nations Type a label Pacific Islander Type a label South or Southeast Asian Type a label White Type a label Two or More Races Type a label Prefer to self-describe Type a label
Type a label from public sources (governmental)Type a label from private contributions (foundations, corporations, organizations); Type a label from earned income; Type a label from special events; and Type a label from investments and other income