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!
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What is your zip code *
What is your age *
Email address
This will not be sold, we send monthly newsletters and event promotional emails
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)? *
Required
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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