Contribution Pledge Survey Form
Please complete this survey to share your pledge intentions and contribution preferences. Your responses will help us understand and organize future contributions.
Full Name
*
First Name
Last Name
What type of contribution do you plan to pledge?
*
Monetary
In-kind goods
Volunteer time
Other
How often do you intend to contribute?
*
One-time
Monthly
Quarterly
Annually
Other
What is the approximate amount or value range of your intended contribution?
*
Please Select
Less than $100
$100 - $499
$500 - $999
$1,000 or more
Not sure yet
Preferred method of contribution
*
Online transfer
Check
Cash
In-person delivery
Other
When do you expect to make your contribution?
*
Please Select
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Date not decided
How motivated do you feel about making this contribution?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I understand how my contribution will be used.
1
2
3
4
5
I feel confident in my ability to fulfill this pledge.
6
7
8
9
10
I would recommend others to pledge as well.
11
12
13
14
15
What motivates you to pledge or contribute?
Any additional notes, constraints, or comments regarding your pledge?
Submit Pledge
Should be Empty: