Thank you for participating!

The information gathered here helps us to evaluate our program, is essential to meet funding requirements, and helps make Calgary Dollars work better for you. Please be assured that your answers are entirely confidential. 

The survey should only take about 5-10 minutes. Each first-time registrant who finishes the survey receives C$20 Calgary Dollars. When you have completed the survey, just send an e-mail to with the phrase "Survey done" in the subject line and you will have your C$ mailed to you.

If have any questions or need assistance completing the survey, please contact us at 403-270-8002 or

Thanks! Calgary Dollars Staff

* 1. What is your first name?

* 2. What is your last name?

* 3. What is your contact information? (ie email address or phone #)

* 4. What is your date of birth? (MMDDYYYY)

Date \

* 5. What gender do you most closely align with? N/A if not binary

* 6. If you are still in school, what grade are you in? N/A if you are not

* 7. Aboriginal identity: Choose only one

* 8. What is your ethno-cultural background? Please choose the one that best applies. 

* 9. What language is spoken MOST OFTEN at home? Choose only one. 

* 10. Were you born in Canada?

* 11. If you were not born in Canada, what is your country of birth?

* 12. If you were not born in Canada, How many years have you lived in Canada?

* 13. How long have you lived in Calgary?

* 14. When did you get involved in Calgary Dollars?

* 15. What neighbourhood do you live in? (please enter a neighbourhood such as Sunnyside, Southview, etc. If you don't know your neighbourhood, please enter your postal code).

* 16. What are the first 3 digits of your postal code?

* 17. Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?

* 18. Does a physical condition or mental condition or health problem reduce the amount or the kind of activity you can do?

* 19. How did you find out about this program (Calgary Dollars)? Choose only one.

* 20. If you entered 'Other' to the question above, pick one or more of the below to answer how you found out about Calgary Dollars. Check as many as are applicable.

* 21. What is your marital status?

* 22. How many adults (over age 18) are there in your household?

* 23. How many children under age 18 are there in your household?

* 24. What are the ages of the children in your household? (If applicable)

* 25. Do you have someone to have a good time with when you want to?

* 26. Do you have someone to show you love and affection?

* 27. Do you have someone to turn to for suggestions about how to deal with a personal problem?

* 28. Do you have someone to take you to the doctor if you needed it?

* 29. Do you have someone to help with daily chores if you were sick?

* 30. Do you have someone to prepare your meals if you were unable to do it yourself?

* 31. Do you have someone to look after your child(ren) for several hours if needed (if applicable)?

* 32. Do you have someone to look after your spouse for several hours if needed (if applicable)?

* 33. Do you have someone to look after your parents for several hours if needed (if applicable)?

* 34. I worry about whether the money I have will be enough to support myself and (if applicable) my family.

* 35. Compared to your financial situation a year ago, are you and (if applicable) your family are:

* 36. Do you think that a year from now you (and your family) will be:

* 37. Do you see a need in Calgary for the Calgary Dollars program?

* 38. Do you have any other comments or suggestions about Calgary Dollars?