Fill Out this Survey and Post a Listing to Receive your free C$20!

The information gathered here helps us to evaluate our program, which is essential to meet our 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 person who registers for the first time, posts a listing, and finishes the survey receives free C$20 Calgary Dollars. 

If you have any questions or need assistance completing the survey, please contact us at 403-270-8002 or info@calgarydollars.ca.
 
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 \
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* 6. If you are still in school, what grade are you in? N/A if you are not.

* 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?

* 15. What neighbourhood do you live in? (please enter a neighbourhood such as Sunnyside, Southview, Castleridge, etc).

* 16. Please enter the first 3 digits of your postal code.

* 17. Please pick the best option for each question:

  Yes, Often Yes, sometimes No
Does a physical or mental condition or health problem reduce the amount or the kind of activity you can do?
Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
Do you find you face language / cultural barriers here in Calgary?

* 19. 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. Total number of adults (18 or older) in your household, including yourself?

* 22. Total number of people under the age of 18 in your household, including yourself?

* 24. Part 1. How often is each of the following kinds of support available to you if you need it:

  Never A little of the time Some of the time Most of the time Always
Do you have someone to have a good time with?
Do you have someone to turn to for suggestions about how to deal with a personal problem?
Do you have someone to take you to the doctor if you needed it?
Do you have someone to prepare your meals if you were unable to do it yourself?
Do you have someone to help with daily chores if you were sick?

* 25. Part 2. How often is each of the following kinds of support available to you if you need it:

  Never A little of the time Some of the time Most of the time Always N/A
Do you have someone to look after your child(ren) for several hours if needed (if applicable)?
Do you have someone to look after your spouse for several hours if needed (if applicable)?
Do you have someone to look after your parent(s) for several hours if needed (if applicable)?

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

Thank you! To get your free C$20, be sure to post a listing on our website.

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