Please fill out the survey below

 

What city do you live in?
What activities would interest you? [Please check all that apply]
Arabic Language Classes
Academic Tutoring
Café
Debkah Classes
Baby Sitting/Day Care
Movie/Play Screenings
Leisure Facilities such as:
      Soccer
      Basketball
      Volleyball
      Billiards
      Table Tennis
      Backgammon
ESL (English as Second Language)
Cultural Education
Cooking Classes
Cross Stitching Classes
Banquet Hall
Social Services such as:
      Immigration
      Legal
      Medical
      Professional
Other:

How many miles would you drive to utilize service(s)?

How many days of the week would you visit the center if the above services were available?

Suggestions:


Your Contact Info for Future Announcements:
Name: First Last
Address:
City: State Zip Code
Phone Number:
Email:
  Yes, I would like to be a volunteer