A Week of Color Survey

Thank you for your participation in this survey! Once you have completed this form, you will be taken to a webpage with a link to the video series. We appreciate your time and support!

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* 1. Contact Information

Name

ZIP/Postal Code

Email Address

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* 2. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to answer

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* 3. Please specify your ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Prefer not to answer

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* 4. To which gender identity do you most identify?

Woman

Man

Transgender Woman

Transgender Man

Gender Variant / Non-conforming

Prefer not to answer

Other (please specify)

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* 5. Are you currently a subscriber of Lakewood Center for the Arts?

Yes, I am currently a subscriber

No, but I have subscribed in the past

No, I have never been a subscriber

Prefer not to answer

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* 6. How do you plan to use this series?

I'm going to watch the series myself

I'm an educator and I plan to share the series with my students

Other (please specify)

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* 7. How did you hear about the A Week of Color series?

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* 8. Additional Comments

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* 9. Privacy agreement

I consent to my information being collected and saved.
*Lakewood does not sell or otherwise distribute collected information. The information collected through this survey is for internal and grant use only and helps us to better understand our audience and the community we serve. Thank you.