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The Salvation Army Fond du Lac
Strengths & Happiness Assessment
Helping you build a better tomorrow.
(Ripon residents, do you need assistance? Your area is served by
The Salvation Army Service Extension
)
Head of Household Name
*
Address
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
AA
AE
AP
Phone Number
Email
Best Way to Contact?
Phone Call
Text
Email
What's your preferred method of communication?
*
Email
Phone
Date of Birth
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Tell Us a Bit About You
Highest Education Level Completed
(Choose One)
High School/GED
Tech School (2 year program)
University (4 year program)
Other
Other (Explain)
Are you employed?
(Choose One)
Yes
No
Additional Income
SSDI
Child Support
TANF
Other
Other (Explain)
Please select your annual income:
Under $2,000
$2,000 - $4,999
$5,000 - $9,999
$10,000 - $14,999
$15,000 - $19,999
$20,000 - $24,999
$25,000 - $29,999
$30,000 - $34,999
$35,000 +
Tell us ONE of the biggest challenges in your life.
How did you overcome that challenge?
What do you like about yourself?
What do you enjoy doing?
What's your dream (and what's keeping you from achieving it?)
What are you proud of in your life?
What are your three greatest strengths?
What do you get complimented on the most?
In 6 months, how would you like your life changed?
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