Retiree Connection Skills Survey

Personal Information

If you are interested in volunteering through the Retiree Connection, please fill out the following form. The information you provide will help us find the best volunteer placement to match your needs and interests. Any demographic information that you provide will only be used for funding purposes by Serve Yavapai. If you have any questions, please contact Nicole Stanton at 928-848-7870 or retireeconnection@serveyavapai.org.

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1. Please provide the following contact information:

First and Last Name: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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2. How do you prefer to communicate with us?

Phone

In person

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3. How did you find out about the Retiree Connection?

Yavapai College's Osher Lifelong Learning Institute

Word of Mouth

Serve Yavapai Website

Other (please specify)

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4. When were you born?

Before 1930

1930-1935

1936-1940

1941-1945

1946-1950

1951-1955

1956-1960

1961-1964

1965-1970

After 1970

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5. What do you consider your race and ethnicity to be?

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6. What gender do you identify with?

Female

Male

Other (please specify)

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7. What is the highest level of education that have you completed?

Elementary School

Middle School

High School Diploma or Equivalent

Some College

2 Year Associates Degree

Bachelor’s Degree

Master’s Degree

Doctoral Degree

Trade/Vocational(please specify)

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1. Please provide the following contact information:

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2. How do you prefer to communicate with us?

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3. How did you find out about the Retiree Connection?

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4. When were you born?

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5. What do you consider your race and ethnicity to be?

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6. What gender do you identify with?

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7. What is the highest level of education that have you completed?

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8. Please share a little bit about your background that you feel is relevant: