THIS SURVEY WILL ONLY BE LIVE FOR 72 HOURS – ALL INFORMATION WILL BE KEPT CONFIDENTIAL AND ONLY PRESENTED IN THE AGGREGATE WITHOUT IDENTIFYING INFORMATIONThis survey is an attempt to gather information from Houses of Worship and Allied Organizations for the purpose of 1.) Developing a Coalition Profile 2.) Baseline Data to guide our plan. We are asking you to please complete this quick survey, which should take no longer than 3 -5 minutes. Name *FirstLastEmail *EmailConfirm EmailHouse of Worship Name: *Are You the Senior/Highest ranking Leader in the Local House of Worship? *Select From the Drop Down ListNoYesHouse of Worship Address: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHouse of Worship Phone Number:2. Please indicate, all organizational affiliations you may have.The 400 Foundation, Inc.Empire Baptist Missionary Convention Inc. of NYSM-PAC (Mobilizing Preachers and Community)AACEO (African American Clergy and Elected Officials)NAN (The National Action Network)The Ark of JusticeEastern Baptist AssociationUnited Missionary Baptist AssociationBishop/FellowshipProgressive Baptist Convention AssociationAME 1st Episcopal District | Brooklyn-Westchester DistrictAME 1st Episcopal District | Manhattan DistrictAME 1st Episcopal District | Jamaica-Long Island DistrictChurch of God in ChristCongregational ChurchesEast Brooklyn CongregationsMinisters CoalitionUnited Free WillEvangelicalAfrican Methodist Episcopal Zion ChurchUnited Methodist Episcopal ChurchChristian Methodist Episcopal ChurchMonday Night ConferenceBronx Ministers ConferenceProgressive Baptist MinistersSeven Day Adventist ChurchNon-DenominationalPresbyterian ChurchBaptist Minister Conference of Greater New York and VicinityLutheran ChurchChurch of GodOtherIf you selected Bishop/Fellowship, enter your Fellowship and Bishops Name. If you selected Other, enter details.3. We want to demonstrate our collective numbers and strength, please enter the number of members on your house of worship membership role + regular visitors + the number of people your congregation reaches in the community and online. (Your individual information will not be made public, but in an anonymous format we will make public collective numbers)4. 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. (copy)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):5. As we begin building a plan, please identify the types of ministry and programming your house of worship is currently engaged in, please select all that apply. After School ProgramCommunity Beautification/RevitalizationCounselingDay CareEducational WorkshopsFeeding ProgramsFinancial LiteracyFood PantryHealth ServicesHomeless ServicesRental/Bill AssistanceSenior ProgrammingSocial MediaStreaming ServicesVoter RegistrationWorkforce Development/Skills TrainingYoung Adult MinistryYouth MinistryOther6. Please select areas where you could benefit from additional funding and/or cost savings.Additional StaffingAfter School ProgramBuilding MaintenanceCapital ImprovementsCommunity Beautification/RevitalizationCounselingDay CareEducational WorkshopsFeeding ProgramsFinancial LiteracyFood PantryHealth ServicesHomeless ServicesInsuranceMarketing and Promotional MaterialsPaper ProductsPrinting CostsRental/Bill AssistanceRetirement PlanSenior ProgrammingSocial MediaStreaming ServicesUtility ExpensesVoter RegistrationWebsite DevelopmentWorkforce Development/Skills TrainingYoung Adult MinistryYouth MinistryOtherOther Financial Needs: (Please List)7. Please provide a contact name and contact information for someone other than the Senior Leader of the House of Worship who can serve as a point of contact.Church Contact Person: *FirstLastChurch Contact Person Email: *EmailConfirm EmailChurch Contact Person Mobile Phone: *8. In order to help us design an educational campaign please answer the following question about your Sunday Services.What time(s) is your Sunday Worship Service(s)?Are you worshipping in person?Select from the Drop Down ListNo YesDo you record your Sunday Service live from the sanctuary/church?Select from the Drop Down ListNoYesDo you pre-record Sunday Service outside of the sanctuary/church?Select from the Drop Down ListNoYesHow do you stream your Sunday Service?Select from the Drop Down ListFacebookYouTubeLivestreamChurch WebsiteInstagramRestreamOtherIf other, indicate service provider.EmailSubmit
