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URL:
https://act.communitychangeaction.org/a/guaranteed-income-survey?sourceid=1041659
Submission: On July 14 via api (July 14th 2024, 4:57:08 pm UTC) from BE — Scanned from IT

Form analysis
1 forms found in the DOM

POST v1

<form class="clearfix" method="post" novalidate="" action="v1" accept-charset="utf-8" autocomplete="on">
  <div class="at-markup FastAction" id="NVSignupForm1919349-FastAction">
    <div class="fastaction-block">
      <div class="fastAction clearfix">
        <p>
          <span class="fa-cta">
            <a href="#fastaction-login" class="profile-link" aria-label="FastAction">
          <img class="profile-link-fa-image" src="//static.everyaction.com/ea-actiontag/assets/images/fast-action.svg"> 
        </a>
            <span><a href="https://fastaction.ngpvan.com##whats-this" class="circle" id="fastaction-whatsthis" data-popup="true" data-popup-width="515" data-popup-height="540" target="_blank">?</a></span>
          </span>
          <span class="fa-lead"> Take future action with a single click.<br>
            <a href="#fastaction-login" class="call-modal" id="fastaction-widget-login">Log in</a>&nbsp;or&nbsp;<a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a>&nbsp;for <i>Fast</i><b>Action</b>
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  <div data-name="undefined" data-subview="submit_view" data-subview-index="3"></div>
  <fieldset class="at-fieldset ContactInformation" id="NVSignupForm1919349-ContactInformation">
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      <div class="at-row FirstName LastName"><label class="at-text   FirstName" id="NVSignupForm1919349-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
            title="First Name (required)" name="FirstName" value="" maxlength="20" placeholder="First Name ">
        </label><label class="at-text   LastName" id="NVSignupForm1919349-ContactInformation-LastName">Last Name <small>(Optional)</small><input type="text" autocomplete="family-name" x-autocompletetype="surname" false="" title="Last Name"
            name="LastName" value="" maxlength="25" placeholder="Last Name">
        </label></div>
      <div class="at-row at-row-solo PostalCode"><label class="at-text   PostalCode" id="NVSignupForm1919349-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
            pattern="^\d{5}([\-]\d{4})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10" placeholder="Postal Code ">
        </label></div>
      <div class="at-row at-row-solo EmailAddress"><label class="at-text   EmailAddress" id="NVSignupForm1919349-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
            pattern="^([\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&amp;'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
            name="EmailAddress" value="" maxlength="100" placeholder="Email ">
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      <div class="at-row at-row-solo YesSignMeUpForUpdatesForBinder"><input id="YesSignMeUpForUpdatesForBinder_Value" type="hidden" name="YesSignMeUpForUpdatesForBinder.Value" value="true"></div>
      <div class="at-row at-row-solo at-row-full UpdateMyProfile at-mode-person-only">
        <div class="at-markup UpdateMyProfile at-mode-person-only" id="NVSignupForm1919349-ContactInformation-UpdateMyProfile">
          <div class="updateMyProfileSection" style=""><label style="display:inline;"><input type="checkbox" name="updateMyProfile" checked="checked"><span><span class="text">Remember me so that I can use <i>Fast</i><b>Action</b> next
                  time.</span></span></label></div>
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      <div class="at-row "><label class="at-text   PersonalUrl" id="NVSignupForm1919349-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
        </label></div>
      <div class="at-row "><input id="SocialNetworkTrackingId_Value" type="hidden" name="SocialNetworkTrackingId.Value"></div>
      <div class="at-row "><input id="SocialNetwork_Value" type="hidden" name="SocialNetwork.Value"></div>
      <div class="at-row ">
        <div class="at-markup TrackingPixel" id="NVSignupForm1919349-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
            src="https://secure.everyaction.com/v1/Track/ty6OxKoWS06LYPm1A0wfBg2?sourceid=1041659&amp;formSessionId=0e55c9b0-0499-419c-a341-35538460c99c&amp;bName=chrome&amp;dType=desktop&amp;formVersion=6/11/2024 3:15:28 PM|4/26/2023 7:59:57 PM&amp;fUrl=aHR0cHM6Ly9hY3QuY29tbXVuaXR5Y2hhbmdlYWN0aW9uLm9yZy9hL2d1YXJhbnRlZWQtaW5jb21lLXN1cnZleT9zb3VyY2VpZD0xMDQxNjU5&amp;fRef=aHR0cHM6Ly9hY3QuY29tbXVuaXR5Y2hhbmdlYWN0aW9uLm9yZy9hL2d1YXJhbnRlZWQtaW5jb21lLXN1cnZleT9zb3VyY2VpZD0xMDQxNjU5"
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  <fieldset class="at-fieldset AdditionalInformation" id="NVSignupForm1919349-AdditionalInformation">
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    <div class="at-fields">
      <div class="at-row at-row-full CustomFormFieldQuestion_553666581474083_MappedParagraphQuestion_479935405356905">
        <label class="at-area   CustomFormFieldQuestion_553666581474083_MappedParagraphQuestion_479935405356905" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_553666581474083_MappedParagraphQuestion_479935405356905">What would
          it mean for you and your family to receive an extra $500-$1,000 every month in direct, no-strings-attached cash? What would become possible for you if you were a recipient of a guaranteed income program?<textarea required=""
            title="What would it mean for you and your family to receive an extra $500-$1,000 every month in direct, no-strings-attached cash? What would become possible for you if you were a recipient of a guaranteed income program? (required)"
            name="CustomFormFieldQuestion_553666581474083_MappedParagraphQuestion_479935405356905" maxlength="8000"></textarea>
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      <div class="at-row at-row-full CustomFormFieldQuestion_3153563434412927_MappedParagraphQuestion_3201776627048929">
        <label class="at-area   CustomFormFieldQuestion_3153563434412927_MappedParagraphQuestion_3201776627048929" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3153563434412927_MappedParagraphQuestion_3201776627048929">Are
          there any reasons why you wouldn’t support a guaranteed income? <small>(Optional)</small><textarea false="" title="Are there any reasons why you wouldn’t support a guaranteed income?"
            name="CustomFormFieldQuestion_3153563434412927_MappedParagraphQuestion_3201776627048929" maxlength="8000"></textarea>
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      <div class="at-row at-row-full CustomFormFieldQuestion_88618791783427">
        <div class="form-unit form-unit-radio form-item-customformfieldquestion_88618791783427" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_88618791783427"><label
            id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_88618791783427"> If you were selected to be a recipient of a guaranteed income program for $1,000 every month, would you continue to work?
            <small>(Optional)</small></label>
          <div class="radios" role="radiogroup" aria-labelledby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_88618791783427">
            <label title="Yes, I would continue to work at my current job with the same hours" class="at-radio-label-7051742684251597" role="radio">
              <input type="radio" name="CustomFormFieldQuestion_88618791783427" value="7051742684251597"> Yes, I would continue to work at my current job with the same hours </label><label
              title="Yes, I would continue to work but I would change jobs or reduce my hours" class="at-radio-label-6473819816091975" role="radio">
              <input type="radio" name="CustomFormFieldQuestion_88618791783427" value="6473819816091975"> Yes, I would continue to work but I would change jobs or reduce my hours </label><label
              title="No, I would take some time off to go back to school, find a new job, or be with my family" class="at-radio-label-2247448527266707" role="radio">
              <input type="radio" name="CustomFormFieldQuestion_88618791783427" value="2247448527266707"> No, I would take some time off to go back to school, find a new job, or be with my family </label><label
              title="No, I would not continue to work" class="at-radio-label-4942822154795907" role="radio">
              <input type="radio" name="CustomFormFieldQuestion_88618791783427" value="4942822154795907"> No, I would not continue to work </label><label title="I am not working now (unemployment, disability, or other reasons)"
              class="at-radio-label-2926320087386647" role="radio">
              <input type="radio" name="CustomFormFieldQuestion_88618791783427" value="2926320087386647"> I am not working now (unemployment, disability, or other reasons) </label>
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      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617">
        <div id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"><label name="CustomFormFieldQuestion_4128173186744617" class="checkbox-list-label"> Select all that apply. How would a guaranteed income positively
            impact your life? With a guaranteed income, I could:&nbsp;<br>
            <small class="checkbox-list-required-text" name="CustomFormFieldQuestion_4128173186744617-small"
              style="display: none"><b>Select all that apply. How would a guaranteed income positively impact your life?   With a guaranteed income, I could: is required.</b></small>
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      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4893959326107481">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4893959326107481" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4893959326107481"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4893959326107481" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4893959326107481-label">Stress less with more
              security</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3076165121445517">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3076165121445517" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3076165121445517"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3076165121445517" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3076165121445517-label">Spend more time with my
              family</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3442032753036751">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3442032753036751" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3442032753036751"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3442032753036751" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_3442032753036751-label">Afford the medical, child or other
              care I need</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_5206615128267995">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_5206615128267995" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_5206615128267995"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_5206615128267995" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_5206615128267995-label">Work fewer hours and do more things
              I enjoy</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1512725092743605">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1512725092743605" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1512725092743605"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1512725092743605" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1512725092743605-label">Volunteer in my local
              community</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_2197317746153587">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_2197317746153587" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_2197317746153587"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_2197317746153587" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_2197317746153587-label">Put toward rent and/or utility
              bills</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4442558431657633">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4442558431657633" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4442558431657633"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4442558431657633" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4442558431657633-label">Start to save for my and my
              family’s futures</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_6963590844449205">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_6963590844449205" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_6963590844449205"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_6963590844449205" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_6963590844449205-label">Go back to school</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1254379550339331">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1254379550339331" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1254379550339331"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1254379550339331" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1254379550339331-label">Quit a second or third
              job</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_7507878633382969">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_7507878633382969" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_7507878633382969"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_7507878633382969" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_7507878633382969-label">Travel and take a
              vacation</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1776773225088535">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1776773225088535" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1776773225088535"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1776773225088535" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_1776773225088535-label">Pay down debt and/or student
              loans</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4299390689745463">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4299390689745463" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4299390689745463"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4299390689745463" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_4299390689745463-label">Feel better about
              myself</span></span>
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      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_8914695837426607">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_8914695837426607" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_8914695837426607"><input
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            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_8914695837426607-label">Repair my home or car</span></span>
        </label>
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      <div class="at-row at-row-full CustomFormFieldQuestion_4128173186744617_QuestionOtherResponse_1090091288372379">
        <label class="at-check  CustomFormFieldQuestion_4128173186744617_QuestionOtherResponse_1090091288372379" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_QuestionOtherResponse_1090091288372379"><input
            type="checkbox" name="CustomFormFieldQuestion_4128173186744617_QuestionOtherResponse_1090091288372379" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617_QuestionOtherResponse_1090091288372379-label">Other</span></span>
        </label>
        <label class="at-text   QuestionOtherResponse_1090091288372379_QuestionOtherTextResponse_6432411159887841" id="NVSignupForm1919349-AdditionalInformation-QuestionOtherResponse_1090091288372379_QuestionOtherTextResponse_6432411159887841"
          style="display: none;"><kbd>Other</kbd><input type="text" autocomplete="on" required="" title="Other (required)" name="QuestionOtherResponse_1090091288372379_QuestionOtherTextResponse_6432411159887841" value="" maxlength=""
            placeholder="Other ">
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671">
        <div id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671"><label name="CustomFormFieldQuestion_3248513489281671" class="checkbox-list-label"> Select all that apply. Do you identify with any of the following
            groups of people who may be considered for guaranteed income in the future?&nbsp;<small>(Optional)</small><br>
            <small class="checkbox-list-required-text" name="CustomFormFieldQuestion_3248513489281671-small"
              style="display: none"><b>Select all that apply. Do you identify with any of the following groups of people who may be considered for guaranteed income in the future? is required.</b></small>
          </label>
        </div>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4875046648133401_MappedActivistCodeQuestion_4899300">
        <label class="at-check  CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4875046648133401_MappedActivistCodeQuestion_4899300"
          id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4875046648133401_MappedActivistCodeQuestion_4899300"><input type="checkbox"
            name="CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4875046648133401_MappedActivistCodeQuestion_4899300" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title"
              id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4875046648133401_MappedActivistCodeQuestion_4899300-label">Parents and children</span></span>
        </label>
      </div>
      <div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_988925302192275">
        <label class="at-check  CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_988925302192275" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_988925302192275"><input
            type="checkbox" name="CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_988925302192275" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671"> <span
            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_988925302192275-label">People of color</span></span>
        </label>
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              style="display: none"><b>Select all that apply. How do you want to get involved in the campaign for a guaranteed income? is required.</b></small>
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              id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317-label">Join a virtual text or phone bank</span></span>
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              id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116-label">Share posts on social media</span></span>
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              id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409-label">Share my story</span></span>
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            class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4874829158139867-label">Write an op-ed or letter to the
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              id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542-label">Contact my elected officials</span></span>
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    <div class="at-markup secure-processing-single-step-div" style="display: none;">
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      </label>
    </div>
  </div>
</form>

Text Content

Guaranteed income programs work. More than 100 guaranteed income pilot programs
around the country have proven successful, as well as stimulus through COVID and
the expanded Child Tax Credit, which significantly reduced child poverty. That's
why polls show that a majority of Americans now support guaranteed income
programs that offer social and economic empowerment to people who need it most.

Poverty is a policy choice. We have the resources right now to abolish poverty
and expand economic freedom to include millions of Americans. Fully realized,
economic freedom means that we have the agency and power to make decisions about
our lives.

Can you take 5-10 minutes to complete our guaranteed income survey and tell us
why economic freedom matters to you?

Guaranteed Income Survey



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Contact Information
First Name Last Name (Optional)
Postal Code
Email

Remember me so that I can use FastAction next time.
(Optional)



Survey
What would it mean for you and your family to receive an extra $500-$1,000 every
month in direct, no-strings-attached cash? What would become possible for you if
you were a recipient of a guaranteed income program?
Are there any reasons why you wouldn’t support a guaranteed income? (Optional)
If you were selected to be a recipient of a guaranteed income program for $1,000
every month, would you continue to work? (Optional)
Yes, I would continue to work at my current job with the same hours Yes, I would
continue to work but I would change jobs or reduce my hours No, I would take
some time off to go back to school, find a new job, or be with my family No, I
would not continue to work I am not working now (unemployment, disability, or
other reasons)
Select all that apply. How would a guaranteed income positively impact your
life? With a guaranteed income, I could: 
Select all that apply. How would a guaranteed income positively impact your
life? With a guaranteed income, I could: is required.
Stress less with more security
Spend more time with my family
Afford the medical, child or other care I need
Work fewer hours and do more things I enjoy
Volunteer in my local community
Put toward rent and/or utility bills
Start to save for my and my family’s futures
Go back to school
Quit a second or third job
Travel and take a vacation
Pay down debt and/or student loans
Feel better about myself
Repair my home or car
Other Other
Select all that apply. Do you identify with any of the following groups of
people who may be considered for guaranteed income in the future? (Optional)
Select all that apply. Do you identify with any of the following groups of
people who may be considered for guaranteed income in the future? is required.
Parents and children
People of color
Young people
Dislocated workers
Seniors with little or no retirement income
Formerly incarcerated people
Immigrants
Unhoused people
People with disabilities
People with excessive medical and/or student loan debt
Unpaid family caregivers
Gig economy workers
Select all that apply. How do you want to get involved in the campaign for a
guaranteed income? (Optional)
Select all that apply. How do you want to get involved in the campaign for a
guaranteed income? is required.
Join a virtual text or phone bank
Share posts on social media
Share my story
Write an op-ed or letter to the editor
Volunteer
Contact my elected officials
Host local events
Other Other
Your donation will be securely processed.


Disclaimer: Thank you for taking the time to complete our guaranteed income
survey. We take care to protect your data and privacy. Your responses will be
kept confidential. Any response data shared outside of Community Change Action
will be anonymized to prevent responses you provide from being associated with
you as an individual.





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