Rockingham County Community Conversation at Eden Boys & Girls Club

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Rockingham County Community Conversation at Eden Boys & Girls Club – Monday, January 12th, 7:00 - 9:00PM ET

The Harwood Institute for Public Innovation has partnered with the Reidsville Area Foundation on a community initiative to catalyze change.

This initiative has three primary goals: (1) illuminate key issues that matter to people and better understand the community's underlying conditions; (2) ensure that our partners investments create sustainable impact that align with community aspirations and needs; and (3) strengthen Rockingham's civic culture so the community can take action on what matters to people.

Conversations are taking place across the Rockingham area this winter season with one scheduled for Monday, January 12th at Eden Boys & Girls Club at 5:30PM ET. All conversation participants will receive a $25 gift card.

Thank you so much for your willingness to participate. As part of registering for this conversation, we collect demographic information to ensure our conversations accurately reflect the community. Your information will not be shared publicly in any way.

Full Name *

Email address (if you have one) *

Phone Number *

Occupation *

Are you available to attend the conversation at Eden Boys & Girls Club from 5:30 - 7:30PM ET on January 12th? If not, we can send you other conversation times in case you are able to attend at a different time.
*

Yes

Would you like to receive a $25 gift card for participating? *

Yes

What part of the community do you live in? *

Gender *

Female

Male

Transgender Female

Transgender Male

Non-binary

Prefer not to identify

Other:

Age *

Race *

Asian/Asian American

Black or African American

Hispanic or Latino/a

Native Hawaiian or other Pacific Islander

Native American or Indigenous

White

Multi-Racial (specify in notes)

Prefer not to say

Highest Education Level *

Some high school

High school GED

Technical Certificate/Associate's Degree

Some College

Bachelor's Degree

Higher Degree

Prefer not to say

Number of people in your household (including you): *

Household income *

$0 - 24,999

$25K - 49,999

$50K - 74,999

$75K - 99,999

$100K +

Prefer not to say

Would you like a copy of the Rockingham community report sent to your email once it is published? *

Yes

Would you like to be added to The Harwood Institute's email list? *

Yes

How did you hear about this conversation? *

Flyer

Word of mouth

Facebook

Other social media

Other:

Do you have any thoughts, questions or comments? *

Submit

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