How can we best connect with you? Survey

Welcome to Congregation Shalom's Member Survey

As we are working to contain the spread of COVID-19, we are concerned about how everyone is doing. We want to be able to stay connected using the phone, email, streaming, remote group education as well as in other ways. We are asking you to complete one survey per household today to help us obtain information about the best ways to remain connected to you. The results of this survey will help us better understand the type of technology that is available to you. We are also considering creating a new program that will give us the ability to deliver food to members in need. We would very much appreciate information from you about your interest in participating if we do start this program. Thank you so much for completing and submitting this questionnaire. Your feedback is very important to us.

YOUR RESPONSES WILL BE KEPT CONFIDENTIAL!
Reminder: Please complete one survey per household.

1.Please provide your first name, last name, cell phone number and home phone number.

First Name

Last Name

Cell Phone

Home Phone

2.If you have a cell phone, does it have the ability to send and receive text messages?

Yes

3.If you are not single, please provide the first and last name of the other adult in your household.

First Name

Last Name

Cell Phone

4.Does this cell phone have the ability to send and receive text messages.

Yes

5.Please select the one option that best describes the quickest way to provide you with information regarding changes in synagogue operations?

Other (please specify)

7.Do any of your devices have both a camera and a microphone?

Yes

8.What type of assistance are you in need of at this time.

I/we are in need of groceries

I/we are in need of medications

I/we would like to receive a periodic check-in call from the synagogue

Other (please specify)

9.What kinds of concerns do you have for your personal well-being or the well-being of a family member?

10.We know there are people in our synagogue community who will be in need of food. In order to address this need, we are looking into ways to prepare and deliver meals to congregants. We estimate the meal cost to be about $15 per meal. If we move forward with this program, please indicate how you would like to participate.

Would like to receive a prepared meal

Would like to assist by delivering meals

Would like to assist by contributing to the cost of food for this program.

Other (please specify)

11.Feel free to share other comments with us.

12.Do you have family in town who can assist you?

We greatly appreciate you taking the time to complete this survey!
Rabbi Noah, Rabbi Rachel, Cantor Karen, Rabbi Jenn