PPHP Alumni Signup Form
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1. PPHP Peer Educator & Volunteer Alumni Survey
*
1
. Please enter your information.
Please enter your information.
Name:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code:
Email Address:
Phone Number:
2
. What have you been doing since you left Planned Parenthood and moved into adulthood? Please check all that apply.
What have you been doing since you left Planned Parenthood and moved into adulthood? Please check all that apply.
College
Graduate school
Employment
Extended domestic or international travel
Currently single or dating
Currently in relationship
Currently engaged, married or in domestic partnership
Currently expecting or have children
Military/Peace Corps
Volunteer
Other (please specify)
3
. If you attended, or are currently attending, college, what was/is your major?
If you attended, or are currently attending, college, what was/is your major?
Architecture/Engineering
Business
Communications/Journalism
Computer Science
Economics/Finance
Education
English/Literature
Fine Arts
Graphic Arts
History
Mathematics
Natural Science
Political Science
Psychology
Sociology/Anthropology
Other (please specify)
4
. What is your current/recent occupation/industry?
What is your current/recent occupation/industry?
Administrative/Support Services
Architect/Engineer
Banking/Finance
Business Owner
Business Manager
Communications/Public Relations
Computer - IT - Technology
Cosmetology
Consultant
Customer Service
Education
Fine Artist or Entertainer
Government/Civil Service
Health Care
Homemaker
Hospitality
Human Resources
Insurance
Internet
Legal
Manufacturing
Marketing
Non-Profit
Product Research & Development
Psychology/Psychiatry
Public Relations
Publishing
Sales
Scientific Research
Social Work
Other (please specify)
5
. Are you currently involved with PPHP or another Planned Parenthood affiliate?
Are you currently involved with PPHP or another Planned Parenthood affiliate?
Yes
No
6
. What year(s) were you involved with PPHP?
Example: 2000-2003
What year(s) were you involved with PPHP? Example: 2000-2003
7
. What was your role?
What was your role?
Peer Educator
Volunteer
Intern
Other (please specify)
8
. In which PPHP area are you most interested?
In which PPHP area are you most interested?
Administrative
Education
Fund Raising
Marketing
Internet
Marketing - Research
Public Affairs
Other (please specify)
9
. Which of the following most closely describes the type of involvement with PPHP you would like?
Which of the following most closely describes the type of involvement with PPHP you would like?
Online: Networking, Meet Up, Facebook, etc.
In-person: Reunion, Advocacy, volunteer for PPHP events
Subscribe: PPHP Alumni Newsletter, Choice News, Smart Talk
Other (please specify)
10
. Is there any other news or information you would like to share with us? Awards? Interesting experiences? Other?
Is there any other news or information you would like to share with us? Awards? Interesting experiences? Other?
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