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