Raffle Entry & Communications Survey

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* Please give us your complete contact information:

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

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* What is your preferred telephone contact information?

Primary Telephone Number

Secondary Phone Number

Alternate Phone Number

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* What is your date of birth? (MM/DD/YYYY)

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* Who, if anyone, currently lives with you in your household? Please include permanent residents only. (Please select all that apply.)

Child

Grandchild

Parent

Grandparent

Roommate / Friend

Romantic partner (spouse, partner, boyfriend, girlfriend, etc.)

None of the above

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* What is your relationship status?

Name of Spouse/Significant Other (Include last name if different from yours):

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* Do you have any children under 18 living with you?

Yes

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* If you have any children living with you at least part of the year, please list their names in the appropriate age group. (Include last names if different from yours.)

Infant - Age 5

Age 6 - Age 10

Age 11 - Age 13

Age 14 - Age 17

Age 18 or older

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* How do you and other members of your household identify? (You may answer more than one.)

Conservative

Orthodox

Reconstructionist

Reform

"Just Jewish"

Not Jewish

Other (please specify)

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* Do you consider yourself (or your household) a member or active participant at any of the following Synagogues:

Hebrew Orthodox Congregation

Midwest Torah Center

Sinai Synagogue

Temple B'nai Shalom

Temple Beth-El

Other (please specify)

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* What is the highest level of education you have completed?

What was your primary area of study?

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* What do you consider to be your primary career?

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* Please indicate which social media platforms you use:

	Usage
FaceBook	FaceBook Usage menu
Linkedin	Linkedin Usage menu
Twitter	Twitter Usage menu
SnapChat	SnapChat Usage menu
WhatsApp	WhatsApp Usage menu
Tumblr	Tumblr Usage menu

Other (please specify)

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* How often do you want to hear from the Federation?

Once a week or more

A few times a month

Once a month

A few times a year

Less frequently than that

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* What types of Federation programs do you want to be contacted about?

	No More Than Weekly	Monthly	Quarterly	Never
Children & Youth Programs (Camp Ideal, BBYO, Jr. Youth Group, School Vacation Days, etc.)	Children & Youth Programs (Camp Ideal, BBYO, Jr. Youth Group, School Vacation Days, etc.) No More Than Weekly	Children & Youth Programs (Camp Ideal, BBYO, Jr. Youth Group, School Vacation Days, etc.) Monthly	Children & Youth Programs (Camp Ideal, BBYO, Jr. Youth Group, School Vacation Days, etc.) Quarterly	Children & Youth Programs (Camp Ideal, BBYO, Jr. Youth Group, School Vacation Days, etc.) Never
Young Adult Programs (Dor Hadash, Bar Nights, Giving Circles, etc.)	Young Adult Programs (Dor Hadash, Bar Nights, Giving Circles, etc.) No More Than Weekly	Young Adult Programs (Dor Hadash, Bar Nights, Giving Circles, etc.) Monthly	Young Adult Programs (Dor Hadash, Bar Nights, Giving Circles, etc.) Quarterly	Young Adult Programs (Dor Hadash, Bar Nights, Giving Circles, etc.) Never
Family Programs (PJ Library, Purim Carnival, Family Outings, etc.)	Family Programs (PJ Library, Purim Carnival, Family Outings, etc.) No More Than Weekly	Family Programs (PJ Library, Purim Carnival, Family Outings, etc.) Monthly	Family Programs (PJ Library, Purim Carnival, Family Outings, etc.) Quarterly	Family Programs (PJ Library, Purim Carnival, Family Outings, etc.) Never
Adult Programs (Community Celebrations, Forever Learning, etc)	Adult Programs (Community Celebrations, Forever Learning, etc) No More Than Weekly	Adult Programs (Community Celebrations, Forever Learning, etc) Monthly	Adult Programs (Community Celebrations, Forever Learning, etc) Quarterly	Adult Programs (Community Celebrations, Forever Learning, etc) Never
Cultural Arts Programs (Art Exhibits, Film Festival, Performances, etc.)	Cultural Arts Programs (Art Exhibits, Film Festival, Performances, etc.) No More Than Weekly	Cultural Arts Programs (Art Exhibits, Film Festival, Performances, etc.) Monthly	Cultural Arts Programs (Art Exhibits, Film Festival, Performances, etc.) Quarterly	Cultural Arts Programs (Art Exhibits, Film Festival, Performances, etc.) Never
Academic Programs (Classes, Yom Iyyun, Lectures, etc.)	Academic Programs (Classes, Yom Iyyun, Lectures, etc.) No More Than Weekly	Academic Programs (Classes, Yom Iyyun, Lectures, etc.) Monthly	Academic Programs (Classes, Yom Iyyun, Lectures, etc.) Quarterly	Academic Programs (Classes, Yom Iyyun, Lectures, etc.) Never
Travel Opportunities (Day Outings, Domestic Trips, Missions and International Travel, etc.)	Travel Opportunities (Day Outings, Domestic Trips, Missions and International Travel, etc.) No More Than Weekly	Travel Opportunities (Day Outings, Domestic Trips, Missions and International Travel, etc.) Monthly	Travel Opportunities (Day Outings, Domestic Trips, Missions and International Travel, etc.) Quarterly	Travel Opportunities (Day Outings, Domestic Trips, Missions and International Travel, etc.) Never
Volunteer Opportunities (Committees, Event Planning, Fundraisers, etc.)	Volunteer Opportunities (Committees, Event Planning, Fundraisers, etc.) No More Than Weekly	Volunteer Opportunities (Committees, Event Planning, Fundraisers, etc.) Monthly	Volunteer Opportunities (Committees, Event Planning, Fundraisers, etc.) Quarterly	Volunteer Opportunities (Committees, Event Planning, Fundraisers, etc.) Never

Other (please specify)

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* How do you prefer hearing about the Federation's programs? (Select all that apply.)

Phone

Mail (postcards, flyers, etc.)

Monthly Newsletter- Our Community News

Social media

Website

Text message

Other (please specify) / Comments

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* In a typical day, how likely are you to use social networking websites?

Extremely likely

Very likely

Moderately likely

Slightly likely

Not at all likely

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* How would you prefer to receive the Federation's Monthly Our Community News Newsletter?

In print by mail

Digital via e-mail

Both by print and via e-mail

None- I do not read the newsletter

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* How often would you prefer to receive the Federation's Our Community News Newsletter?

Monthly (current frequency)

Bi-Monthly (6 times a year)

Quarterly (4 times a year)

None- I do not read the newsletter

Other (please specify)

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* Please let us know how often you read the different sections of Our Community News.

	Always	Sometimes	Never
The Front Cover	The Front Cover Always	The Front Cover Sometimes	The Front Cover Never
From the Desk of the Executive Director	From the Desk of the Executive Director Always	From the Desk of the Executive Director Sometimes	From the Desk of the Executive Director Never
Caring Connections	Caring Connections Always	Caring Connections Sometimes	Caring Connections Never
Jewish Family Services Section (Food Pantry, Lunch & Learn, etc.)	Jewish Family Services Section (Food Pantry, Lunch & Learn, etc.) Always	Jewish Family Services Section (Food Pantry, Lunch & Learn, etc.) Sometimes	Jewish Family Services Section (Food Pantry, Lunch & Learn, etc.) Never
Israel Shlicha Section	Israel Shlicha Section Always	Israel Shlicha Section Sometimes	Israel Shlicha Section Never
Youth & Children Program Section (BBYO, Camp Ideal, PJ Library, etc.)	Youth & Children Program Section (BBYO, Camp Ideal, PJ Library, etc.) Always	Youth & Children Program Section (BBYO, Camp Ideal, PJ Library, etc.) Sometimes	Youth & Children Program Section (BBYO, Camp Ideal, PJ Library, etc.) Never
Adult Program Section (Our Art Gallery Updates, Forever Learning, Book Club, etc.)	Adult Program Section (Our Art Gallery Updates, Forever Learning, Book Club, etc.) Always	Adult Program Section (Our Art Gallery Updates, Forever Learning, Book Club, etc.) Sometimes	Adult Program Section (Our Art Gallery Updates, Forever Learning, Book Club, etc.) Never
Member profile by Gabrielle Robinson	Member profile by Gabrielle Robinson Always	Member profile by Gabrielle Robinson Sometimes	Member profile by Gabrielle Robinson Never
Community Calendar	Community Calendar Always	Community Calendar Sometimes	Community Calendar Never
The Back Cover	The Back Cover Always	The Back Cover Sometimes	The Back Cover Never

Other (please specify)

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* What is your first name?

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* What is your last name?

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* How do you prefer to be addressed?

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* Please give us your complete contact information:

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* What is your preferred telephone contact information?

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* What is your date of birth? (MM/DD/YYYY)

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* Who, if anyone, currently lives with you in your household? Please include permanent residents only. (Please select all that apply.)

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* What is your relationship status?

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* Do you have any children under 18 living with you?

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* If you have any children living with you at least part of the year, please list their names in the appropriate age group. (Include last names if different from yours.)

Question Title

* How do you and other members of your household identify? (You may answer more than one.)

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* Do you consider yourself (or your household) a member or active participant at any of the following Synagogues:

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* What is the highest level of education you have completed?

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* What do you consider to be your primary career?

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* Please indicate which social media platforms you use:

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* How often do you want to hear from the Federation?

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* What types of Federation programs do you want to be contacted about?

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* How do you prefer hearing about the Federation's programs? (Select all that apply.)

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* In a typical day, how likely are you to use social networking websites?

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* How would you prefer to receive the Federation's Monthly Our Community News Newsletter?

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* How often would you prefer to receive the Federation's Our Community News Newsletter?

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* Please let us know how often you read the different sections of Our Community News.

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* Do you have any other comments, questions, or concerns?