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1) Do you believe in Nicklaus Children's Hospital's mission to inspire hope and promote lifelong health by providing the best care to every child?

Yes

2) In what ways have you engaged with Nicklaus Children's Hospital? Please select all that apply.

I donate to Nicklaus Children's Hospital.

My child was treated at Nicklaus Children's Hospital.

My grandchild was treated at Nicklaus Children's Hospital.

A friend or family member has benefitted from care and services at Nicklaus Children's Hospital.

I am a current or former employee of Nicklaus Children's Hospital Foundation or Nicklaus Children's Hospital.

I have attended Nicklaus Children's Hospital's events.

I follow on social media.

I have volunteered at Nicklaus Children’s Hospital.

Other

2a) Other - Please specify:

Please specify:

2b) How frequently do you engage with Nicklaus Children's Hospital?

How frequently do you engage with Nicklaus Children's Hospital?

Weekly

Monthly

Every few months

Yearly

Rarely or never

Other

2b-i) Other - Please specify:

Please specify:

3) 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.

4) Which aspects of Nicklaus Children's Hospital'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

Creating Awareness and Generating Funds for Nicklaus Children's Hospital

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Amazing Patient Care - Championing World Class Pediatric Care in South Florida

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Operational Excellence - Investments in Innovative Programs, Services and Facilities

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Building the Future - Responding to What Patients and Families Care About

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

Focusing on Us - Creating a Unified and Talented Team

First Priority

Second Priority

Third Priority

Fourth Priority

Fifth Priority

5) Was (or is) there a person, friend, or family member in your life who inspired your appreciation of Nicklaus Children’s Hospital?

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 Nicklaus Children's Hospital continues to advance accessible, world-class pediatric care in South Florida?

Of utmost importance

Very important

Somewhat important

Not very important

Not important at all

7) Supporters often recognize the need to help Nicklaus Children's Hospital in our efforts to bring about a healthy future for every child. 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

Supporting the Forward for Generations Campaign to help transform pediatric care for the children who need it most

I already have

I am likely

I am somewhat likely

I am not likely

Making an annual donation by check or credit card

I already have

I am likely

I am somewhat likely

I am not likely

Speaking with a gift officer about making a meaningful impact

I already have

I am likely

I am somewhat likely

I am not likely

Setting up a recurring monthly contribution

I already have

I am likely

I am somewhat likely

I am not likely

Giving through a Donor-Advised Fund (DAF) or family foundation

I already have

I am likely

I am somewhat likely

I am not likely

Donating appreciated assets such as stocks, bonds, or rental real estate

I already have

I am likely

I am somewhat likely

I am not likely

Making a Qualified Charitable Distribution (QCD) from my IRA

I already have

I am likely

I am somewhat likely

I am not likely

Creating a gift that provides a lifetime income for me or my loved ones

I already have

I am likely

I am somewhat likely

I am not likely

Contributing through Children’s Miracle Network or a community fundraising event

I already have

I am likely

I am somewhat likely

I am not likely

8) Many people like to include a gift to charity in their will or estate plan to support causes that are important in their life. Would you consider including a gift to Nicklaus Children's Hospital to benefit the children and families who need it most?

I have included a gift for Nicklaus Children's Hospital in my will, trust, or by beneficiary designation.

I am interested in making this type of gift to Nicklaus Children's Hospital.

Not now, but in the future I would definitely be interested in making this type of gift to Nicklaus Children's Hospital.

Not now, but in the future I might possibly be interested in making this type of gift to Nicklaus Children's Hospital.

I am not 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.

Nicklaus Children's Hospital 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?

Smart Ways to Make an Impact Now

Plan With Purpose: Giving Options That Work for You

Gifts That Pay You Income

Simple Ways to Create Your Legacy

Help Ensure a Healthy Future for Every Child

Make a Gift That’s Matched: 75 for 75 Legacy Challenge

9) How does Nicklaus Children's Hospital 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 Nicklaus Children's Hospital?

Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of Nicklaus Children's Hospital?

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 Nicklaus Children's Hospital on my own.

I would like Nicklaus Children's Hospital 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 Nicklaus Children's Hospital.

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

Business owner or entrepreneur

Self-employed

Unemployed

Disabled

Board member for a nonprofit

Where do you serve as a board member?

Please specify your profession:

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

I would like to update my contact information.

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