Name *FirstLastEmail *Survey Purpose: For far too long the black church and houses of worship have been taken for granted and simply used as a platform of political candidates to show up during election season and not in every case, but in far too often, the next time we see them is the next election cycle. After 400 years it is time to organize and quantify our collective voting power to take steps to ensure that 2020 Forward things look different for Black communities to ensure that we build on the last 400 years for a better tomorrow. Disclaimer: The information provided will remain private, kept confidential, and will not be distributed to third parties. The information will be presented in the aggregate to ensure that each individual house of worships information is protected and not disclosed to the public.We are asking you to please complete this quick 5 question survey, which should take no longer than 3 minutes. 1. Can we count you in to stand with us to promote an agenda that has the goal of building out a faith-based infrastructure across New York State to ensure that we see a jump in Black income levels and the growth of Black businesses? *Choose from Drop DownYes, Count Me In!Not at This TimeChurch Name:Church Address:Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeChurch Phone Number:2. We want to show our numbers, please enter the number of members in your house of worship including regular visitors.3. We have to start organizing and demonstrating our collective economic power, please list each financial institution that your house of worship does business with (i.e., Chase, Bank of America, Wells Fargo, TD Bank, etc.). Check ALL That Apply.Chase BankCarver BankBank of AmericaWells FargoU.S. BankKey BankTD BankM&T BankCitibankCapital One BankHSBC BankNew York Community BankCitizens BankPeople's United BankNBT BankTrustCo BankSterling National BankApple BankSantander BankFive Star BankOtherOther Bank Institution(s):4. We have to begin to help our houses of worship not just survive, but thrive, by aligning resources and opportunities that help us carry out our missions. Please list your house of worships TOP 3 areas of greatest financial need: Food PantryAfter School ProgramAdditional StaffingFeeding ProgramsYouth MinistryYoung Adult MinistryUtility ExpensesBuidling MaintenancePaper ProductsMarketing and Promotional MaterialsWebsite DevelopmentSocial Media MarketingStreaming ServicesPrinting CostsInsuranceRetirement PlanCapital ImprovementsOtherOther Financial Needs: (Please List)Please provide a contact name and contact information for someone who can help us organize and stay in touch within your house of worship.Church Contact Person: *FirstLastChurch Contact Person Email:Church Contact Person Mobile Phone:NameSubmit
