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Madina Institute's Youth Interest Survey
This survey is for youth in high school, or between the ages of 14-17 years.
To help us develop programs and activities that meet your interests, please fill out this survey. We will only use your email to send you updates about programs that you are interested in.
Name *
Your answer
Birthday *
MM
/
DD
/
YYYY
Gender *
Email *
Your answer
Cell phone number (optional)
Your answer
How long does it take you to get to Madina Institute from home? *
Please indicate convenient times for your participation in your preferred masjid events. Please check all that apply. *
Required
How frequently would you participate in any programs of interest at Madina Institute? *
Please indicate your level of interest in the following youth activities. (1 indicates least interest and 5 indicates most interest). Basketball? *
Ping pong? *
Soccer? *
Bowling? *
Hiking? *
Picnic/bbq? *
Team scavenger hunts? *
Outdoor games? *
Movie night? *
Build-a-pizza and ice cream social? *
Ramadan youth qiyam night? (overnight at the masjid) *
Field trips? (eg zoo, aquarium, auto show, ball games, etc) *
What other ideas do you have for youth activities? Please list. (optional)
Your answer
Which service area would you participate in? Please check all that apply *
Required
What other service ideas do you have? (optional)
Your answer
Please list any religious/self-improvement lectures you would be interested in attending? (optional)
Your answer
Would you be interested in joining a Youth group at Madina Institute that is run by the youth? *
Would you be interested in being a part of the Leadership Team that develops the Youth group program? *
Other comments/feedback (optional)
Your answer
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