2015 Fairview and Ebenezer Foundations Donor Survey

Your feedback is vital. By sharing your thoughts, you help us improve our efficiency and impact. As a token of our appreciation for completing this survey, you can enter your name into a drawing to win a $50 Target gift card. Thank you!

Question Title

* 1. To what extent do you agree or disagree with the following statements?

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
My gifts are appreciated.	My gifts are appreciated. Strongly Agree	My gifts are appreciated. Agree	My gifts are appreciated. Neutral	My gifts are appreciated. Disagree	My gifts are appreciated. Strongly Disagree
Fairview and Ebenezer do a good job sharing how my gifts are used.	Fairview and Ebenezer do a good job sharing how my gifts are used. Strongly Agree	Fairview and Ebenezer do a good job sharing how my gifts are used. Agree	Fairview and Ebenezer do a good job sharing how my gifts are used. Neutral	Fairview and Ebenezer do a good job sharing how my gifts are used. Disagree	Fairview and Ebenezer do a good job sharing how my gifts are used. Strongly Disagree
I receive acknowledgement for my donation(s) in a timely manner.	I receive acknowledgement for my donation(s) in a timely manner. Strongly Agree	I receive acknowledgement for my donation(s) in a timely manner. Agree	I receive acknowledgement for my donation(s) in a timely manner. Neutral	I receive acknowledgement for my donation(s) in a timely manner. Disagree	I receive acknowledgement for my donation(s) in a timely manner. Strongly Disagree
I am satisfied with the level of recognition I currently receive for my gifts.	I am satisfied with the level of recognition I currently receive for my gifts. Strongly Agree	I am satisfied with the level of recognition I currently receive for my gifts. Agree	I am satisfied with the level of recognition I currently receive for my gifts. Neutral	I am satisfied with the level of recognition I currently receive for my gifts. Disagree	I am satisfied with the level of recognition I currently receive for my gifts. Strongly Disagree

(Optional) Comments:

Question Title

* 2. What interest area(s) inspire you to give? (Please check all that apply.)

Cancer care/Oncology

Chemical dependency

Community health and outreach

Ebenezer

Emergency services

Heart care

Hospice

Mental health

Orthopedics/Sports medicine

Senior services

Spiritual care and clinical pastoral education

Wellness

Women's health

Youth Grief Services

Other (please describe)

Question Title

* 3. What most motivates your health care giving? (Please check one.)

Direct patient care and comfort

Research and innovation

Gratitude for care and services received

Comfortable facilities/rooms and state-of-the-art equipment

Educating and training nurses and caregivers

Valuable community asset that deserves our support

Question Title

* 4. With which Fairview community hospital or clinic do you most strongly identify?

Fairview Lakes Medical Center (Wyoming)

Fairview Maple Grove Medical Center

Fairview Northland Medical Center (Princeton)

Fairview Ridges Hospital (Burnsville)

Fairview Southdale Hospital (Edina)

I don't identify with a particular hospital

Fairview Clinic or Other (please specify)

Question Title

* 5. Please indicate your interest level in attending the following kinds of events:

	Very interested	Somewhat interested	Neutral	Probably not interested	Definitely not interested
Behind-the-scenes tour	Behind-the-scenes tour Very interested	Behind-the-scenes tour Somewhat interested	Behind-the-scenes tour Neutral	Behind-the-scenes tour Probably not interested	Behind-the-scenes tour Definitely not interested
Speaker/lecture series	Speaker/lecture series Very interested	Speaker/lecture series Somewhat interested	Speaker/lecture series Neutral	Speaker/lecture series Probably not interested	Speaker/lecture series Definitely not interested
Donor recognition event	Donor recognition event Very interested	Donor recognition event Somewhat interested	Donor recognition event Neutral	Donor recognition event Probably not interested	Donor recognition event Definitely not interested
Gala/fundraising luncheon	Gala/fundraising luncheon Very interested	Gala/fundraising luncheon Somewhat interested	Gala/fundraising luncheon Neutral	Gala/fundraising luncheon Probably not interested	Gala/fundraising luncheon Definitely not interested
Webinar with health expert	Webinar with health expert Very interested	Webinar with health expert Somewhat interested	Webinar with health expert Neutral	Webinar with health expert Probably not interested	Webinar with health expert Definitely not interested

Question Title

* 6. How do you prefer to receive information from Fairview and Ebenezer? (Check all that apply.)

Print/mail

Social media

Website

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* 7. Are Fairview and/or Ebenezer named in your estate plan?

Yes

Question Title

* 8. There are ways to provide for your family while still making a planned gift to Fairview and/or Ebenezer. Would you like to speak with a foundation representative about planned giving options?

Yes. The best way to reach me is...

Question Title

* 9. Please share a few words about why you choose to give.

Question Title

* 10. (Optional) Provide your name and current contact information to enter your name in a drawing to win a $50 Target gift card as a token of our appreciation.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 11. (Optional) What is your birthdate (mm/dd/yy)?

Thank you for your time and generosity!