What is your employment status? Select status... Employed Self-employed Civil Servant (Beamter)

Is your annual gross income above €73,800? Yes No

Are you married or in a registered relationship? Yes No

How many children do you have? 0 1 2 3 or more

The following conditions may affect your eligibility:

• HIV
• Diabetes 1 or 2
• Multiple Sclerosis
• ADHD
• Mental Health Conditions
• Psychotherapy in the past 5 years
• Currently taking PrEP

Do you have or have you had any of the following? Yes No