Living Water AME Church Community Survey

Getting to Know You

Please answer these questions to let us know a little about you.

By completing all seven questions in this survey and fully submitting them along with your contact information, you will be entered into a drawing for one (1) of the six (6) "Thank You" gift cards.

Question Title

* 1. Tell us your age

Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75-84

85+

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* 2. What is your 5 digit zip code for?

Home

Work

Church

School

Other

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* 3. How do you attend church?

Virtually (i.e. Zoom, FaceBook Live (Meta), YouTube, etc.)

Hybrid. I attend in person sometimes and I attend virtually sometimes.

I attend in person.

I attended church in the past (either in person or virtually), but neither at this time.

I do not attend church in person nor virtually.

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* 4. Are you comfortable going out and engaging in your local community? (e.g. delivering meal to a local shelter, participating in distribution of hats and gloves during the winter, giving out gift/food baskets during the holidays, etc.)

Yes. If I have an opportunity.

I'll go out in my community, but I'm not engaging anyone.

Not sure. It depends on what is going on.

I'd rather not.

Question Title

* 5. Do you have a mentor or someone you talk to about your day-to-day life experiences?

Yes. I communicate with my mentor/friend regularly.

I do, but my current mentor/friend is not really helping me much.

Not presently, but I would like to have one.

I don't need a mentor/friend. I can take of everything myself.

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* 6. In what area(s) listed below can we offer support to you?

Mental health support

Spiritual support

Financial wellness

Offering a listening ear.

Other (please specify)

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* 7. List three ways you would be willing to participate in giving back to your community.

Option A

Option B

Option C

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* 8. Please provide contact information

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code *

Country

Email Address *

Phone Number