Name
*
First Name
Last Name
Email Address
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How did you first become connected to CHSW? I have in the past or present...
Please check all that apply
Been an adoptive parent
Been an adoptee
Benefited from our services
Been an employee
Been an intern or volunteer
A friend or friend's family member who benefited from our services
Been in the social work profession
What motivates your giving to CHSW?
Please check all that apply.
I want to give back for services received
I want to help children and families in need
I want to invest in programs that deliver positive outcomes
I’m convinced that CHSW is an effective organization
I feel blessed and wish to share with others
I want to support organizations that keep the community strong
What CHSW funding need or program are you most interested in supporting?
Early Learning
Family Support and Parent Training
Adoption Services
Child and Family Counseling
Basic needs for families in economic hardship
Innovations and advocacy work
Comprehensive and integrated services for every family
Greatest needs of CHSW at any given point in time
How satisfied are you currently with the information you receive from CHSW about the programs you care about?
Please mark the number that corresponds with your answer.
1 - Very Dissatisfied
2
3
4
5 - Very Satisfied
Please tell us why:
How satisfied are you currently with the information you receive from CHSW about the impact of your giving?
Please select the number that corresponds best with your answer.
1 - Very Dissatisfied
2
3
4
5 - Very Satisfied
Please tell us why:
How do you prefer to receive information and updates from CHSW?
Please check all that apply.
Electronically, via email
Electronically, via social media posts on Facebook
Print and mail
How often do you visit the CHSW website?
Rarely
Regularly
Only when I need specific information about CHSW services
Have you ever visited or take a tour of any CHSW's family resource centers, early learning centers or offices?
Yes
No
If yes, which one/s?
Are you interested in taking a tour of CHSW's family resource centers, early learning centers or offices?
Yes
No
If yes, which one/s?
How does CHSW rank among your giving priorities?
CHSW is my number one giving priority
CHSW is among my giving priorities
CHSW is important, but not among my giving priorities
Have you included CHSW as one of the beneficiaries of any of the following: your will, living trust, retirement plan, life insurance policy, or stock/annuity/bank account?
Yes
No
If yes, which one/s?
Do you intend to include CHSW as one of the beneficiaries of any of the following: your will, living trust, retirement plan, life insurance policy, or stock/annuity/bank account?
Yes
No
If yes, which one/s?
CHSW is launching a financial and estate planning education program in 2017 to serve the needs of our constituents.
Please check all the topics below that would interest you.
Planning for Your Loved Ones
Tax-wise Ways to Provide for Family and Charity
Estate Planning for Retirement Plans
Maximizing Social Security
Smart Ways to Provide for Grandkids
Duties of Trustees and Personal Representatives
Special Needs Trusts
Financial Planning Basics
What time of day would be most convenient for you if you were invited to a CHSW event or education program?
Check all that apply.
Mid-morning
Luncheon
Mid-afternoon
Early evening
Do you have any comments or suggestions that would help us to strengthen our relationship with supporters like you?
Education
High School
Technical/Vocational
Associate's Degree
Bachelor's Degree
Post-graduate
Occupation
Homemaker
Part-time worker
Full-time worker
Retired
Marital Status
Single
Divorced
Married
Widowed
Age
25-39
40-49
50-59
60-69
70-79
80+
Family Information
No children
Have children
Have children and grandchildren
Have children, grandchildren and great-grandchildren