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W2W Demographic Survey
Thank you for taking your time to help us get to know you better!
Your Name and Contact Information
Please ensure we have your correct contact information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Get Involved
Please check all of the boxes that apply. Thank you!
Would you like to be added to our mailing list?
Are you interested in volunteering with our organization?
Are you interested in learning more about being a Board member?
Are you interested in learning more about becoming a Guide?
History
W2W, or Woman to Woman Kentuckiana, is a sister organization to Woman Within International. Please select all of the below that apply to you or that you have completed:
Currently in a W2W Circle
Previously in a W2W Circle (formerly known as E-Circles)
W2W Circle Training
Woman Within Circle (outside of the Kentuckiana area)
Current W2W Board Member
Former W2W Board Member
Current W2W Guide
Former W2W Guide
Woman Within Weekend
Woman Within Staff Training
Staffed a Woman Within Weekend
Woman Within Weekend Facilitator
Woman Within Skills
Woman Within Level 2
26 Day Racial Equity Journey
MKP’s Unpacking Power Privilege and Difference (UPPD)
Discover Your Woman Within: A Journey to Wholeness (Char Tosi)
W2W Wisdom Circles
W2W Intro to Women's Work
Other (provide details below)
Please provide details
Please provide details
No longer involved?
If you are no longer participating in W2W or Woman Within, we would love to understand why. We invite you to share any feedback or circumstance for us to consider.
Demographic Information
Woman to Woman Kentuckiana has dedicated 2021 to ensuring we provide a safe space for everyone, and we’ve invested significant resources to understand how we can improve here. Please help us by providing the information below so that we can understand who we currently are so that we can make sure that anyone, regardless of differing statuses, will feel welcome, heard, and held with us.
Age
*
select one
1900 - 1945 Traditionalists
1946 - 1964 Baby Boomers
1965 - 1980 Generation X
1981- 1996 Millennials
1997 - 2012 Generation Z
Prefer not to disclose
Race
*
select one
White/Caucasian
African/Afr. Am.
Hispanic/Latinx
Asian/Asian Am.
Pacific Islander
Indigenous/Native Am.
Biracial/Multiracial
Other
Prefer not to disclose
(Dis)Ability
*
select one
Physical
Emotional
Developmental
Cognitive/Neurodivergent
None or N/A
Other
Prefer not to disclose
Sexual Orientation
*
select one
Heterosexual
Lesbian
Bisexuality
Asexual
Queer
Pansexual
Questioning
Other
Prefer not to disclose
Gender
*
select one
Cisgender (identify as gender assigned at birth)
Transgender
Non-binary
Gender fluid
Gender queer
Other
Prefer not to disclose
Social Class
*
select one
$32,048 or less a year
$32,048 - $53,413 a year
$53,413 - $106,827 a year
$106,827 - $373,894 a year
$373,894 and Up a year
Other
Prefer not to disclose
Religion
*
select one
Agnostic
Atheist
Bah`a'i
Buddhist
Christian
Hindu
Jewish
Muslim
Pagan
Spiritual
Other
Prefer not to disclose
Caregiver Status
*
select one
None/NA
Children age 0 - 17
Adults age 18+
Prefer not to disclose
Stay Connected!
Would you like to be added to our email/mail list?
Yes, please add me to the mailing list