Form Center

2. Operating Support Grant Demographics

   Thank you for taking a few minutes to complete this demographic survey of staff and board members for the Arts Center's Operating Support Grant Report.

   Note that all responses are anonymous.  We appreciate your time and support of the Arts Center.

4. Your Age Group*
   -- Select One --Age 0 - 18Age 19 - 24Age 25 - 64Age 65+
5. Geographic Location*
   -- Select One --Urban (50,000+ Residents)Large Town (10,000 - 49,999 Residents)Small Town (2,500 - 9,999 Residents)Rural (2,499 or less Residents)
7. Distinct Populations

   1. Individual with Disabilities
   2. Individual below poverty line
   3. Military Veteran / Active Duty Personnel
   4. Individual in Institution (Nursing Facility, Shelter, Assisted Living)

   Select all that apply

8. Race / Ethnicity*

   1. American Indian / Alaska Native
   2. Asian
   3. Black / African American
   4. Hispanic / Latino
   5. Native Hawaiian / Other Pacific Islander
   6. White
   7. Middle Eastern / North African

   Select all that apply

Leave This Blank:


10. 1. Receive an email copy of this form.
11. Email address

    This field is not part of the form submission.

12. Submit

* indicates a required field