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* 1. What categories best define your CURRENT OR PAST relationship with Central? (please check all that apply):

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* 2. The following categories represent Central’s core service areas. On a scale from 0 to 10, with 10 meaning “great interest” and 0 meaning “no interest”, please rate your level interest in the following:

  0 1 2 3 4 5 6 7 8 9 10
Arts & Culture (Music, Dance, Hip Hop, Painting etc.)
Strengthening/Stabilizing Families
Youth Education and Development
Services and programs for Senior Citizens
Workforce / small business development
Community-building / Community events (e.g. Community dinners, holiday celebrations, etc.)

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* 3. Central also has several other activities that happen throughout the year. On a scale from 0 to 10, with 10 meaning “great interest” and 0 meaning “no interest”, please rate your level of interest in the following:

  0 1 2 3 4 5 6 7 8 9 10
Attending our Village Maker Awards/Other fundraising events for Central
Participating in Social Justice Dialogues and Advocacy
Participating in/sponsoring our CommuniTEE-Off Golf Outing
Providing Donations based on Individual/Family Needs
Providing Holiday/Seasonal help to families
Volunteering

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* 4. When did you first learn about Central? Please explain how/why you connected with us?

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* 5. What is your preferred method of contact?

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* 6. Do you have any other suggestions with regard to how can we best/better connect with you moving forward?

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* 7. Finally, so we can be sure to contact you in the future (per your above preferences!), could you please provide us with your contact information?

(Central Community House does NOT share, sell, or exchange the above contact information. This contact information is only used for Central Community House communications.)

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