United Way Survey for Big Brothers Big Sisters

Big Brothers Big Sisters has long partnered with the United Way for funding to be able to match children with mentors. The United Way has asked us if we can reach out to you and collect some demographic data from you. Please answer the survey below with your information. No specific information will be released about you, we will only report on overall statistics of all parents combined in our program. I thank you in advance for replying with the info and helping us fulfill this request to the United Way.

Name(Required)

First Last

What is your ethnicity?(Required)

What is your birthdate? (month/day/year)(Required)

How many immediate family members, including yourself live your household?(Required)

What is the highest level of education you have completed?(Required)

What is your household income?(Required)

Please confirm the email address we have on file for you, or update it if it has changed.(Required)

Please confirm the best phone number to contact you at.(Required)

Type of phone number(Required)

Please confirm the home address we have on file for you, or update it if it has changed.(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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