Sir Swante Palm Park Survey

You're invited to share your feedback on the Palm Park project and provide your input!

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* 1. Name (First and Last Name)

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* 2. What is your ZIP Code?

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* 3. What is the best way to reach you?

Phone

Text Message

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* 4. What is your relationship to Palm Park?

Ex: Palm School alum, long-time resident, etc.

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* 5. How did you hear about this project?

Social Media

E-newsletter

Flyer

Community Organization

Friend/Colleague

News Outlet

Other (please specify)

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* 6. Please select all that apply:

Asian or Asian American

American Indian or Alaska Native

Black or African American

Hispanic or Latinx

Native Hawaiian or Pacific Islander

Middle Eastern or North African

White, Caucasian

Two or more races/ethnicities

Migrant or immigrant

Asylum seeker or refugee

LGBTQIA+

Woman

Trans Woman

Man

Trans Man

Non binary/gender-fluid

Differently-abled or disabled

Caregiver to child(ren) under age of 5

Caregiver to child(ren) with special needs

Caregiver to adult

Senior (Age>60)

Youth (Age<21)

Student

Immunocompromised

Veteran

Unsheltered or unstable housing

Other (please specify)

Sir Swante Palm Park Survey

Question Title

* 1. Name (First and Last Name)

Question Title

* 2. What is your ZIP Code?

Question Title

* 3. What is the best way to reach you?

Question Title

* 4. What is your relationship to Palm Park?Ex: Palm School alum, long-time resident, etc.

Question Title

* 5. How did you hear about this project?

Question Title

* 6. Please select all that apply:

* 4. What is your relationship to Palm Park?

Ex: Palm School alum, long-time resident, etc.