Calgary Dollars Intake Survey 2018

   
This program is funded by FCSS.


Fill Out this Survey, and Post a Listing, to Receive your free C$20!                                          

The information gathered here helps us to evaluate our program, which is essential to meet our funding requirements, and helps make Calgary Dollars work better for you. Please be assured that your answers are entirely confidential. 

People take on average 6 minutes to complete it. Each person who registers for the first time, posts a listing, and finishes the survey receives free C$20 Calgary Dollars. 
If you have any questions or need assistance completing the survey, please contact us at 403.270.3200 or info-at-calgarydollars.ca.

Thanks! Calgary Dollars Staff

 

*1) What is your first name?

*2) What is your last name?

*3) What is your contact information? (ie email address or phone #)

*4) What is your date of birth? (Year/Month/Day)

*5) What is your gender?

*6) If you are still in school, what grade are you in? N/A if you are not.

*7) Indigenous / Aboriginal identity: Choose only one

*8) What is your Population Group? Please choose the one that best applies.

*9) What language is spoken most often at home?

*10) Were you born in Canada?

11) If you were not born in Canada, what is your country of birth?

12) If you were not born in Canada, how many years have you lived in Canada?

*13) How long have you lived in Calgary?

*14) When did you get involved in Calgary Dollars?

*15) What neighbourhood do you live in? (please enter a neighbourhood such as Sunnyside, Southview, Castleridge, etc).

*16) Please enter the first 3 digits of your postal code.

*17) Please pick the best option for each question:

Yes, OftenYes, sometimesNo
Does a physical or mental condition or health problem reduce the amount or the kind of activity you can do?
Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
Do you find you face language / cultural barriers here in Calgary?

*18) How did you find out about this program (Calgary Dollars)? Choose only one.

19) If you entered 'Other' to the question above, pick one or more of the below to answer how you found out about Calgary Dollars. Check as many as are applicable.

*20) What is your marital status?

*21) Total number of adults (18 or older) in your household, including yourself?

22) Total number of people under the age of 18 in your household, including yourself?

23) What are the ages of the children in your household? (if applicable) Children 0-17 years of age. (If you have more than one child, separate ages with a comma. ex: For four children: 1, 3, 7, 8).

*24) Part 1. How often is each of the following kinds of support available to you if you need it:

NeverA little of the timeSome of the timeMost of the timeAlways
Do you have someone to have a good time with?
Do you have someone who shows you love and affection? (This is a required funder question, Please answer with your discretion)
Do you have someone to turn to for suggestions about how to deal with a personal problem?
Do you have someone to take you to the doctor if you needed it?
Do you have someone to prepare your meals if you were unable to do it yourself?
Do you have someone to help with daily chores if you were sick?

*25) Part 2. How often is each of the following kinds of support available to you if you need it:

NeverA little of the timeSome of the timeMost of the timeAlwaysN/A
Do you have someone to look after your child(ren) for several hours if needed (if applicable)?
Do you have someone to look after your spouse for several hours if needed (if applicable)?
Do you have someone to look after your parent(s) for several hours if needed (if applicable)?

*26) I worry whether the money I have will be enough to support myself and (if applicable) my family.

*27) Compared to your financial situation a year ago, are you and (if applicable) your family:

*28) Do you think that a year from now you (and your family) will be:

*29) Do you see a need in Calgary for the Calgary Dollars program?

30) Do you have any other comments or suggestions about Calgary Dollars?

Want your free C$20?

  If you have completed the 3 things required: registered, completed this survey successfully, and posted a listing,
we'll mail you free C$20. 
Login to post a listing HERE. (If you go to this link, make sure to return to this window to "submit" your survey below).

Contact us if you have any questions:  info-at-calgarydollars.ca  or  403.270.3200.
 

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