NAGC Member Survey

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* 1. Name of Organization

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* 2. Where are you located (city, state)?

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* 3. Date Completed

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* 4. Total Number of bereaved children served annually in 2013?

Children under 10:

Teens under 18:

Young adults under 25:

Adults over 25:

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* 5. What percentage of current bereaved youth served is represented by each of the following Racial/Ethnic groups?

American Indian or Alaskan Native:

Asian:

Black or African American:

Hispanic/Latino:

Caucasian:

Native Hawaiian or Pacific Islander:

Biracial or Multiracial:

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* 6. What percentage the children and teens you serve reside in the following areas?

Suburban:

Rural:

Inner City:

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* 7. What percentage of the bereaved families you serve fall into each income level?

Under $30,000:

$30,000 - $60,000:

$60,000 - $120,000:

$120,000 and up:

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* 8. How many volunteers do you have?