Survey - SACC Waiting List

	Parent/Guardian's Information
*1.	Question - Required - First & Last Name:
*2.	Question - Required - Address
*3.	Question - Required - City, State, Zip
*4.	Question - Required - Email
*5.	Question - Required - Phone #
	Information on Children in Need of Care
*6.	Question - Required - 1st Child's Name
*7.	Question - Required - 1st Child's Age
*8.	Question - Required - 1st Child's School
*9.	Question - Required - 1st Child's Grade in School
10.	Question - Not Required - 2nd Child's Name
11.	Question - Not Required - 2nd Child's Age
12.	Question - Not Required - 2nd Child's School
13.	Question - Not Required - 2nd Child's Grade in School
	Other Information
*14.	Question - Required - How much money do you make in one year, before taxes?
15.	Question - Not Required - Other circumstance