STEP 6 - Respondent Demographics
Thank you for your patience in completing our demographic information forms. Our donor agencies require that we track demographic information to aid in improved provision of services.
Respondent Demographics
First Name
Last Name
Middle Initial
Date of Birth mm/dd/yyyy
Street Address
City, State
ZIP
Home Phone
Cell Phone
School Name
Grade
Race / Ethnicity
Specify Race / Ethnicity
Main language at home
Second language at home
English Fluent?
Gender
Specify Gender
Household Type
How many people live with you?
Name of Parent/Guardian
Cell Phone Parent/Guardian
Home Phone Parent/Guardian
Submit, then proceed to STEP 7
Impact Survey