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Diaper Bank of Southern Arizona Demographic Data
Collection of this anonymous data helps the DBSA gather a snapshot of the community each agency serves and provides meaningful impact data to our funders. Thank you for helping us help you!
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* Indicates required question
Date
*
MM
/
DD
/
YYYY
Zipcode
*
Your answer
Is this the first time you have received diapers / adult incontinence briefs from THIS AGENCY this year?
Yes
No
Clear selection
Name of agency where you are receiving diapers or adult incontinence products
*
Choose
Amphitheater Public Schools
Arizona Baptist Children's Services
Arizona's Children Association (AzCA)
Arizona Youth Partnership - Gila
Arizona Youth Partnership-Pima
Aviva Children's Services
B'nai B'rith Covenant House
Benson Hospital / TMC Healthcare
Casa de los Niños
Catholic Community Services of Southern AZ
Child and Family Resources
Children's Clinics
Christ Church United Methodist
Community Action Human Resources Agency
Desert Senita Community Health Center
Emerge! Center Against Domestice Abuse
Friendship Missionary Baptist Church
Greater Vail Community Services
Green Valley Assistance Services
Hands of Hope Tucson
IMPACT of Southern Arizona
International Rescue Committee
JobPath, Inc.
Las Artes Pima County
Living Faith Christain Center
Lutheran Social Services of the Southwest
Marana Resource Center -Community Food Bank of Southern Arizona
Marana Unified School District, Family Resource Center
Morris Air National Guard - Airman & Family Readiness Office
Our Family Services - Homeless Youth Services
Pascua Yaqui Tribe Charitable Organization
Pima County Health Department
Sahuarita Food Bank & Community Resource Center
SUSD Teenage Parent Program
The Lending Shed - Family Health Care Amigos
Tohono O'odham Nation Healthcare
Tucson Indian Center
Tucson Unified School District - Teenage Parent High School
U of A Family Resources Center - Santa Cruz
Gender of the Diaper / Adult Brief user
*
Male
Female
Age of the Diaper / Adult Brief user
*
0-17
18-59
60+
Ethnicity of Diaper / Adult Brief user
*
Hispanic
non-Hispanic
Race of the Diaper / Adult Brief user
*
Choose
American Indian
Asian
Black
Pacific Islander
White
American Indian + White
Asian + White
Black + White
American Indian + Black
Other / Multi-Racial
Gender of main income-earner
*
Male
Female
Does the Diaper / Adult Brief user have a place to live?
*
Yes
No
Does the Diaper / Adult Brief user have a disability?
*
Yes
No
How many people are in your household? (Enter number only)
*
Your answer
Verification of financial need
*
Qualifies for a food box
Receives EBT / SNAP benefits
I (or my child) qualify for AHCCS medical benefits
Qualifies for the WIC program
I receive TANF benefits
Required
How many diapers or incontinence products did you receive today? (Enter number only)
*
Your answer
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