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Step 1 of 12 - Q1

1) Why is [INSERT ORG NAME HERE]'s mission important to you?

First Choice

Second Choice

Third Choice

2) Which aspects of [INSERT ORG NAME HERE]'s work are most meaningful to you?

Please rank the following according to their importance to you, with First Priority being your highest priority.

You may only select one answer for each option.

First Priority	Second Priority	Third Priority	Fourth Priority	Fifth Priority

Mission Aspect #1

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Mission Aspect #2

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Mission Aspect #3

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Mission Aspect #4

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Mission Aspect #5

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

3) In what ways have you engaged with [INSERT ORG NAME HERE]? Please select all that apply.

I donate to [INSERT ORG NAME HERE].

A friend or family member [INSERT TYPE OF ENGAGEMENT ie. "was treated", "studied"]

I am a current or former employee of [INSERT ORG NAME HERE].

I have attended [INSERT ORG NAME HERE]'s events.

I follow on social media.

I have visited the website.

Other

3a) Other - Please specify:

Please specify:

3b-i) Other - Please specify:

Please specify:

3b) How frequently do you engage with [INSERT ORG NAME]?

How frequently do you engage with [INSERT ORG NAME]?

Weekly

Monthly

Every few months

Yearly

Rarely or never

Other

4) We like to send supporters like you occasional emails with updates including videos, stories, and information about how we are making an impact on your behalf. Would you like to receive these updates? (You can opt out at any time).

Yes I want to receive occasional emails with updates.

Not at this time.

5) Was there an influential person in your life who inspired your appreciation of [INSERT ORG NAME HERE]?

Yes

5a) If yes, please indicate their relationship to you.

If yes, please indicate their relationship to you.

Parent/grandparent

Spouse/partner/significant other

Child/children

Other family member

Friend

Teacher or professor

Other

5a-i) Other - Please specify:

Please specify:

6) When thinking about future generations, how important is it to you that [INSERT ORG NAME HERE] continues to [INSERT MISSION LANGUAGE HERE]?

Of utmost importance

Very important

Somewhat important

Not very important

Not important at all

7) Supporters often recognize the need to help [INSERT ORG NAME HERE] in our efforts to [INSERT MISSION LANGUAGE]. Would you consider furthering our work in any of the following ways?

I already have	I am likely	I am somewhat likely	I am not likely

Donating online with a credit card

I already have

I am likely

I am somewhat likely

I am not likely

Mailing a check

I already have

I am likely

I am somewhat likely

I am not likely

Talking with a gift officer face-to-face or on the phone about making a substantial impact

I already have

I am likely

I am somewhat likely

I am not likely

Making a recurring contribution

I already have

I am likely

I am somewhat likely

I am not likely

Donating from a Donor-Advised Fund

I already have

I am likely

I am somewhat likely

I am not likely

Donating from a Family Foundation

I already have

I am likely

I am somewhat likely

I am not likely

Giving appreciated assets (such as personal or business stocks or bonds, land or rental real estate, etc.)

I already have

I am likely

I am somewhat likely

I am not likely

Giving property (such as jewelry, artwork or a car)

I already have

I am likely

I am somewhat likely

I am not likely

Transferring a portion of my IRA account to [INSERT ORG NAME HERE] (Qualified Charitable Distribution)?

I already have

I am likely

I am somewhat likely

I am not likely

Making a charitable gift that provides a lifetime income to me or my loved ones

I already have

I am likely

I am somewhat likely

I am not likely

8) Many people like to include a gift to a charity in their will to support the causes that are important in their lives. In the past, you indicated that you may consider making this type of gift for [INSERT ORG NAME HERE]. Would you please share with us the status of your intended gift?

I am pleased to let you know I have documented my intended gift for INSERT ORG NAME HERE]..

I intend to document my gift for [INSERT ORG NAME HERE] in the next 3-6 months.

I would like assistance documenting my intended gift for [INSERT ORG NAME HERE].

I might consider making this type of gift for [INSERT ORG NAME HERE] in the future.

I am no longer interested in this type of gift.

8a) Please tell us about your legacy gift:

Please tell us about your legacy gift:

I planned this gift in honor or in memory of someone.

I would like this gift to go to a specific purpose.

[INSERT ORG NAME HERE] may use this gift where it will do the most good.

8a-i) Please provide the name of and/or association with this person:

Please provide the name of and/or association with this person:

8a-ii) Please describe the intended purpose:

Please describe the intended purpose:

Would you like us to provide additional information to help with your decision?

Guide #1

Guide #2

Guide #3

9) How does [INSERT ORG NAME HERE] rank in comparison to other non-profits you may support?

My top choice for charitable giving

Near the top of my list

Middle of my list

Bottom of my list

Not on my list

9a) Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of [INSERT ORG NAME HERE]?

Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of [INSERT ORG NAME HERE]?

Yes

9a-i) Please let us know the most convenient way to connect:

Please let us know the most convenient way to connect:

I would like to introduce the person(s) to [INSERT ORG NAME HERE] on my own.

I would like [INSERT ORG NAME HERE] to provide me with resources to share with the person(s).

10) We would love to hear your story. If you would like, please share a special memory or experience with [INSERT ORG NAME HERE].

11) About You (optional)

Age

Under 40

40 - 49

50 - 59

60 - 69

70 - 79

80 - 89

90+

Gender

Male

Female

Other/Nonbinary

Prefer not to specify

Please specify:

What is your marital status?

Married

Not married

Divorced

Widowed

Which of the following best describes your family?

No children

One child

Two or more children

Please tell us the highest level of education you completed:

High school graduate or equivalent

Some college

Associate's degree

Bachelor's degree

Advanced degree

Please select the option(s) that best describes your professional life.

Working full time

Working part time

Retiring within 5 years

Retired

Volunteering

Board member for a nonprofit

Business owner or entrepreneur

Self-employed

Disabled

Other

Profession:

Where do you serve as a board member?

Please check the box below if you would like to update your contact information.

I would like to update my contact information.

First name(Required)

Last name(Required)

Address

Address 2

City

State

ZIP

Country

Phone

Email(Required)

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