Duck Pond Questionnaire
This questionnaire will be used to apply for more resources for our non-profit. More resources equals a better program for you!
What is your zip code
Your answer
What is your age
Email address
This will not be sold, we send monthly newsletters and event promotional emails
Your answer
What is your gender?
What best describes your current employment status?
What is the primary language spoken in your household?
What is the highest level of education you have completed?
How would you classify yourself?
What is your current household income?
What is your current marital status?
How many children under 5 do you have in your household?
How many children over age 5 do you have in your household?
How did you hear about The Duck Pond(choose as many that apply)?
Do you currently receive government assistance (CalFresh, CalWorks, WIC) for my family.
I would like to receive email updates from The Duck Pond at Gateway Community Center
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