St. Stephen Catholic Church

Welcome to the 2015 Pulse of the Parish Survey

This survey will be used to understand where our parish has the opportunity to grow and develop. We plan to use this valuable information to shape our future and we plan to share our findings with you through our church communications channels. Thank you for your open and honest feedback, we appreciate your participation.

Please submit one survey per household.

Question Title

* 1. We would like to develop a Parish community email and contact list. Please provide the following information. Thank you.

Name

Address

Address 2

City / Town

State / Province

ZIP / Postal Code

Phone

Question Title

* 2. How many people are in your household?

Question Title

* 3. What are the ages of the people living in your home?

	1	2	3	4	5+
0-9	0-9 1	0-9 2	0-9 3	0-9 4	0-9 5+
10-19	10-19 1	10-19 2	10-19 3	10-19 4	10-19 5+
20-29	20-29 1	20-29 2	20-29 3	20-29 4	20-29 5+
30-39	30-39 1	30-39 2	30-39 3	30-39 4	30-39 5+
40-49	40-49 1	40-49 2	40-49 3	40-49 4	40-49 5+
50-59	50-59 1	50-59 2	50-59 3	50-59 4	50-59 5+
60-69	60-69 1	60-69 2	60-69 3	60-69 4	60-69 5+
70-79	70-79 1	70-79 2	70-79 3	70-79 4	70-79 5+
80-89	80-89 1	80-89 2	80-89 3	80-89 4	80-89 5+
90+	90+ 1	90+ 2	90+ 3	90+ 4	90+ 5+

Question Title

* 4. Please select the race(s) that best describe(s) the people living in your home: Caucasian, African-American, Hispanic or Latino, Asian, Native American, or some other nationality?

Caucasian

African-American

Hispanic/Latino

Asian

Native American

Other race

If other race (please specify)

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25% of survey complete.