How can we best connect with you?

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.

Question Title

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

First Name

Last Name

Cell Phone

Home Phone

Question Title

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

Yes

Question Title

* 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

Question Title

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

Yes

Question Title

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

Phone

Regular Mail

Text Message

Facebook

Other (please specify)

Question Title

* 6. What type of technology is available in your home. (Please indicate all that apply).

PC Computer

Apple Computer

iPhone

Android Phone

Chrome Book

Kindle

Other (please specify)

Question Title

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

Yes

Question Title

* 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)

Question Title

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

Question Title

* 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)

Question Title

* 11. Feel free to share other comments with us.

Question Title

* 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