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2. Please select the gender group served by the program Required field
   -- Select One --Male Female Gender data not available
3. Please select the employment status of your beneficiaries (Select both if apply) - Required field

   1. Employed
   2. Unemployed
   3. Students
   4. Retired
   5. Not in Workforce (other than retired and students)
5. Please select the age-group of individuals served through your program during this reporting period Required field
   -- Select One --17 years and under 18 - 25 years 26 - 59 years 60 years and over
6. Please provide the number of beneficiaries served under the 2024 TN Annual Poverty Limit (refer to definition in the help text below)*

   In Tennessee, the 2024 annual poverty limit for a household of 1 is $20,783, 2 is $28,207, 3 is the $35,632, 4 Is $43,056, 5 is $50,480, 6 is $57,905, 7 is $65,329, 8 is $72,754 and $5,380 for each additional person over 8. 

8. Please select all racial / ethnic demographic groups, currently being served through your program during this reporting period Required field

   1. Asian;
   2. Black or African American;
   3. Hispanic/Latino;
   4. Native American or Alaskan Native;
   5. Native Hawaiian or Pacific Islander;
   6. White;
   7. Other
   8. Other
9. Does your program serve to people with disabilities ?
   -- Select One --YesNo
11. Do any of your project beneficiaries belong to the Veteran group, or does your project run a specific program relevant to the Veteran group's needs under eligible grant activities?
    -- Select One --YesNo
12. Does your program serve the need of Individuals with low literacy in the English Language
    -- Select One --YesNo
14. Do any of your project beneficiaries belong to the rural group, or does your project run a specific program relevant to the rural group's needs under eligible grant activities?
    -- Select One --YesNo

    In Tennessee, the counties considered non-rural according to the US Census Bureau include Shelby, Madison, Sumner, Bradley, Anderson, Loudon, Blount, Carter, Sullivan, Washington, Davidson, Hamilton, Knox, Rutherford, Williamson, Montgomery, and Hamblen.

16. Does your project serve incarcerated individuals, or does your project have any specific program active under the grant budget that is relevant to the needs of incarcerated individuals?
    -- Select One --YesNo
18. Please select the highest level of education completed by your project beneficiaries (Select all that apply) Required field

    1. Not Available;
    2. Grade 0-8;
    3. Grade 9-12 (non-graduate);
    4. High school graduate or GED;
    5. College Student (s);
    6. College Graduate (s);
    7. Post - Graduate (s);
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field