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SNAP Survey
Name
Date of Birth
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Mailing Address
Street Address
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State / Province / Region
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Afghanistan
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Algeria
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Angola
Anguilla
Antarctica
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Australia
Austria
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Bahrain
Bangladesh
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Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
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Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
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Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
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Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Eswatini
Ethiopia
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Finland
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French Guiana
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Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
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Grenada
Guadeloupe
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Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
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Hungary
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India
Indonesia
Iran
Iraq
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Isle of Man
Israel
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Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
Latvia
Lebanon
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Libya
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Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
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Mayotte
Mexico
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
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Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
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Panama
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Poland
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Saint Barthélemy
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Slovakia
Slovenia
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Somalia
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Sudan
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Sweden
Switzerland
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Taiwan
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Tanzania, the United Republic of
Thailand
Timor-Leste
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Türkiye
US Minor Outlying Islands
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Uzbekistan
Vanuatu
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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Phone
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Do you receive SFMNP (Senior Farmers Market Nutrition Program)?
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Are you eligible for SFMNP (Senior Farmers Market Nutrition Program)?
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Are you Native American?
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Do you know about the Cherokee Nation WIC or Tribal Benefits?
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Are you eligible for the Cherokee Nation WIC or Tribal Benefits?
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