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URL:
https://act.communitychangeaction.org/a/guaranteed-income-survey?sourceid=1041659
Submission: On July 14 via api from BE — Scanned from IT
Submission: On July 14 via api from BE — Scanned from IT
Form analysis
1 forms found in the DOMPOST 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> or <a href="#fastaction-signup" class="call-modal" id="fastaction-widget-signup">Sign up</a> for <i>Fast</i><b>Action</b>
</span>
</p>
</div>
</div>
</div>
<div data-name="undefined" data-subview="submit_view" data-subview-index="3"></div>
<fieldset class="at-fieldset ContactInformation" id="NVSignupForm1919349-ContactInformation">
<legend class="at-legend">Contact Information</legend>
<div class="at-fields">
<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})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10" placeholder="Postal Code ">
</label></div>
<div class="at-row at-row-solo EmailAddress"><label class="at-text EmailAddress" id="NVSignupForm1919349-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="Email ">
</label></div>
<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>
</div>
</div>
<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&formSessionId=0e55c9b0-0499-419c-a341-35538460c99c&bName=chrome&dType=desktop&formVersion=6/11/2024 3:15:28 PM|4/26/2023 7:59:57 PM&fUrl=aHR0cHM6Ly9hY3QuY29tbXVuaXR5Y2hhbmdlYWN0aW9uLm9yZy9hL2d1YXJhbnRlZWQtaW5jb21lLXN1cnZleT9zb3VyY2VpZD0xMDQxNjU5&fRef=aHR0cHM6Ly9hY3QuY29tbXVuaXR5Y2hhbmdlYWN0aW9uLm9yZy9hL2d1YXJhbnRlZWQtaW5jb21lLXN1cnZleT9zb3VyY2VpZD0xMDQxNjU5"
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset AdditionalInformation" id="NVSignupForm1919349-AdditionalInformation">
<legend class="at-legend">Survey</legend>
<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>
</label>
</div>
<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>
</label>
</div>
<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>
</div>
</div>
</div>
<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: <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>
</label>
</div>
</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>
</label>
</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
type="checkbox" name="CustomFormFieldQuestion_4128173186744617_CustomFormFieldQuestion_8914695837426607" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_4128173186744617"> <span
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>
</div>
<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? <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>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_5245869002281629">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_5245869002281629" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_5245869002281629"><input
type="checkbox" name="CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_5245869002281629" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_5245869002281629-label">Young people</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4961287577559931">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4961287577559931" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4961287577559931"><input
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4961287577559931-label">Dislocated workers</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_485891512775073">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_485891512775073" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_485891512775073"><input
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_485891512775073-label">Seniors with little or no retirement
income</span></span>
</label>
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<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7012970716424541">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7012970716424541" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7012970716424541"><input
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7012970716424541-label">Formerly incarcerated
people</span></span>
</label>
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<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_1060666641710897_MappedActivistCodeQuestion_4899314">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_1060666641710897_MappedActivistCodeQuestion_4899314"
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class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_1060666641710897_MappedActivistCodeQuestion_4899314-label">Immigrants</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_985696879367169_MappedActivistCodeQuestion_5003703">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_985696879367169_MappedActivistCodeQuestion_5003703"
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class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_985696879367169_MappedActivistCodeQuestion_5003703-label">Unhoused people</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_316009382132757">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_316009382132757" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_316009382132757"><input
type="checkbox" name="CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_316009382132757" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_316009382132757-label">People with
disabilities</span></span>
</label>
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<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4965152143270563_MappedActivistCodeQuestion_4899306">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4965152143270563_MappedActivistCodeQuestion_4899306"
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class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4965152143270563_MappedActivistCodeQuestion_4899306-label">People with excessive medical and/or student loan
debt</span></span>
</label>
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<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4903597445956179">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4903597445956179" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4903597445956179"><input
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_4903597445956179-label">Unpaid family
caregivers</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7285385166771125_MappedActivistCodeQuestion_5124471">
<label class="at-check CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7285385166771125_MappedActivistCodeQuestion_5124471"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7285385166771125_MappedActivistCodeQuestion_5124471"><input type="checkbox"
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class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_3248513489281671_CustomFormFieldQuestion_7285385166771125_MappedActivistCodeQuestion_5124471-label">Gig economy workers</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309">
<div id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"><label name="CustomFormFieldQuestion_6537460388197309" class="checkbox-list-label"> Select all that apply. How do you want to get involved in the
campaign for a guaranteed income? <small>(Optional)</small><br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_6537460388197309-small"
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>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317"><input type="checkbox"
name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5924070342200651_MappedActivistCodeQuestion_4899317-label">Join a virtual text or phone bank</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116"><input type="checkbox"
name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_3367000843921969_MappedActivistCodeQuestion_4959116-label">Share posts on social media</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409"><input type="checkbox"
name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_5844591773148037_MappedActivistCodeQuestion_5019409-label">Share my story</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4874829158139867">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4874829158139867" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4874829158139867"><input
type="checkbox" name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4874829158139867" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
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
editor</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4010840194455047_MappedActivistCodeQuestion_4966255">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4010840194455047_MappedActivistCodeQuestion_4966255"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4010840194455047_MappedActivistCodeQuestion_4966255"><input type="checkbox"
name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4010840194455047_MappedActivistCodeQuestion_4966255" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_4010840194455047_MappedActivistCodeQuestion_4966255-label">Volunteer</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542"><input type="checkbox"
name="CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542" aria-describedby="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title"
id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_8600656715793213_MappedActivistCodeQuestion_5003542-label">Contact my elected officials</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_6845380048773115">
<label class="at-check CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_6845380048773115" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_6845380048773115"><input
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_CustomFormFieldQuestion_6845380048773115-label">Host local events</span></span>
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<div class="at-row at-row-full CustomFormFieldQuestion_6537460388197309_QuestionOtherResponse_3500335861761131">
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class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1919349-AdditionalInformation-CustomFormFieldQuestion_6537460388197309_QuestionOtherResponse_3500335861761131-label">Other</span></span>
</label>
<label class="at-text QuestionOtherResponse_3500335861761131_QuestionOtherTextResponse_300379926296597" id="NVSignupForm1919349-AdditionalInformation-QuestionOtherResponse_3500335861761131_QuestionOtherTextResponse_300379926296597"
style="display: none;"><kbd>Other</kbd><input type="text" autocomplete="on" required="" title="Other (required)" name="QuestionOtherResponse_3500335861761131_QuestionOtherTextResponse_300379926296597" value="" maxlength=""
placeholder="Other ">
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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 ? Take future action with a single click. Log in or Sign up for FastAction 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. SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Sign up with your email address Already have a FastAction account? Log in By clicking "Log in," I confirm that I agree with the FastAction terms of service and privacy policy. × SHOW YOUR SUPPORT WITH A SINGLE CLICK Autofill forms quickly and securely with FastAction Log in with your email address Don't have a FastAction account yet? Sign up By clicking "Sign up," I confirm that I agree with the FastAction terms of service and privacy policy. ×