DSOSN

INDEX

Building Dreams, changing lives and Providing Opportunity for all

2010 Family Membership Survey

Dear DSOSN Family Members,

As the Director of Fund Development, it is my responsibility to research and apply for grants to help fund our programs and services. In my research I have found that many grantors require demographic information to help them determine the population of the community that we serve. DSOSN has never captured this information in this format before that will enable us to calculate statistics of our membership.

Therefore, I am asking for your help. I want everyone to remain anonymous. I don't need to know who are you, just various demographic information about you. This information would be most appreciated and helpful to me when applying for grants to get us more funding. It is my goal to raise as much money as possible so DSOSN can continue in its mission to serve you as a member and support the very important cause of assisting individuals and their families affected by Down syndrome.

Thank you kindly for taking the time to fill out this survey. We hope that by compiling this information of our members we will be able to apply for and receive more grant funding.

Sincerely,

Deann Cline
Director of Fund Development

Please click here to download a hard copy of this survey to mail in

Age Group of Your Child:

	Newborn to Five (5) Years Old
	Six (6) to Eleven (11) Years Old
	Twelve (12) to Eighteen (18) Years Old
	Nineteen (19) to Twenty-Five (25) Years Old
	Twenty-Six and Older

Gender of your child

Male
Female

For Mothers

I was years old when my child was born

Highest level of education in your family:

High School
Some College
4 Year College Degree
Master Degree
Other:

Marital Status:

Married
Single
Separated
Widowed
Divorced
Other:

If there are two parents in your household, please check the following that applies:

Both of us work full-time
One full-time; one part-time
One works full-time and the other is the stay-at-home full-time caregiver
Neither work
Other:

If you are a one parent household, please check where applicable:

Work full-time
Work part-time
Don't work
Other:

Religious affiliation:

Protestant Christian
Roman Catholic
Greek Orthodox
Evangelical Christian
LDS - Mormon
Jewish
Muslim
Hindu
Buddist
Other:

Race:

African American
Asian American
Caucasian
Latino/Hispanic
Multicultural/Ethnic
Other:

Combined family yearly income level:

$25,000 - $30,000
$30,000 - $40,000
$40,000 - $50,000
$50,000 - $75,000
$75,000 or more
Other: (assistance, etc.)

Programs and Services utilized by your family; check all that apply either presently or in the past:

Speech Therapy
Physical Therapy
Music Therapy
Dance Therapy
Spirit Horse Therapy
Lending Resource Library
Hispanic Outreach
Scholarship Program; when funding is available
New Parent Program
Changing Lives Program

Member Socials:

Valentine Party
Spring Fling/Easter
Annual Picnic
Halloween
Holiday Party/Christmas
Young Adult/Teen Club

Please list 1 - 3 programs and services that we offer that are the most valuable to your family:

What other programs and services would you like to see DSOSN implement?

Optional but IMPORTANT Question:

If you would be so kind as to list where you work. The reason for this is that many grants will only be granted if members of a non-profit are employees at a given place and/or volunteer for that non-profit. Example: Southwest Gas, Wells Fargo, etc.
I/we work at:

Does your place of employment offer a Matching Gift Program?

Yes
No
Don't know

How long have you been a member of DSOSN?

New member less than one year
1 - 2 years
2 - 5 years
5 - 10 years
10 or more