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INRC 2020 Fall Workshop: Planning for Healthy Communities
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
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Phone
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Address
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Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Your Neighborhood
Fees for Workshops
Each of the workshops now has a fee of $10. The fee helps to cover the cost of the class, staff time, and assists in continuing these workshops. Scholarships are available. If you wish to request a scholarship, please call INRC at 317-920-0330 to register.
Promo Code
Amount
$
Fees for Workshops
*
$10
-
Cost to attend one training
$20
-
Cost to attend one training for myself and my donation toward another person's scholarship to attend
$
How did you hear about INRC's workshops?
*
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Facebook
Twitter
E-Newsletter
Word of Mouth
Website
Neighbor
INRC staff
Other
Number in Household (Should include all the persons who occupy or live in the home)
Age
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less than 19
19-24
25-39
40-54
55-64
65-74
75-84
85+
Gender
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Female
Gender nonconforming
Male
Transgender
Prefer not to answer
Race
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African-American Black
American Indian/Alaskan Native
Asian
Bi-racial
Caucasian/White
Hawaiian/Pacific Islander
Multi-racial
Other
Prefer not to answer
Are you Hispanic/Latinx or Spanish Origin?
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Yes
No
Prefer not to answer
Marital Status
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Married
Domestic Partner
Single (never married)
Separated
Divorced
Widowed
Employment Status
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Employed Full-time (35 hours or more per week)
Employed Part-time (less than 35 hours per week)
Unemployed (seeking employment)
Not in the workforce (homemaker, disabled, retired, etc.)
Other
Highest Level of Education Completed
select one
Less than high school
High school/GED
Some college
Two-year degree
Technical degree/certification
Four-year degree
Master's degree
Doctorate degree
INRC respects an individual’s right to keep certain personal information private. Any information provided in this demographic questionnaire is recorded anonymously and will be used solely by INRC for the important purposes of improving and reporting our program offerings and fundraising. INRC will not sell, trade, or transfer an individual’s personal information to any third party or entity. If you have any questions or concerns regarding the information you provide in this survey, please contact us at info@inrc.org. Thank you.
Add 3% to my total amount to help cover the payment processing fees