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Nana’s Circle Interest Survey
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Email *
Name *
Phone Number *
What is your age? *
How many children do you provide full-time care for? *
What are the ages of the children you provide full-time care for? *
Would you like to receive weekly check-in calls from our interns? *
If you would like to receive weekly check in calls, what day and times are best. Please list all.
What is the #1 challenge you are facing in caregiving? *
What is the #2 challenge you are facing in caregiving? *
What is the #3 challenge you are facing in caregiving? *
What is the #1 NEED you are have in caregiving? *
What is the #2 NEED you are have in caregiving? *
What is the #3 NEED you are have in caregiving? *
Are there any questions you have that you’d like help getting answered?
Is there anything else you’d like to share? *
Thank for taking the time to complete this survey. Nana’s Circle is on a mission to BE the circle that bridges the gap connecting caregivers to their village. We are here to support you.
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