WFAC Demographic Questionnaire

Thank you for taking the time to fill out this questionnaire. Collecting this information helps us secure grants and federal funding. Every question is optional and you do not have to answer anything you do not want.

This optional form is the same one we use for all programs at The Center. Since it covers every age group, a few questions might not fit your child—feel free to skip those or select 'Prefer not to answer'.

Participant's name

First Name

Last Name

How does this participant identify?

What is the participant's race or ethnicity?

Does the participants identify as any of the following LGBTQ+?

What language(s) does the participant speak most fluently?

What is your household's income bracket?

Does the participant identify as having a disability?