Individual Survey

1
Your Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Home Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Employer* This field is required.
6
LinkedIn Profile Optional
7
Are you only interested in serving on a 501(c)(3) nonprofit board?* This field is required.Some people only want to work with this specific type of organization. If you're unsure right now, that's fine.
Yes
No
Unsure
8
Areas of interest* This field is required.List up to five
Animals
Arts
Children/Youth
Civic engagement
Economic development
Education
Environment / Conservation
Equity / Inclusion
Food insecurity
Health
Housing Affordability
Human rights
Immigration
Job training / workforce development
Public Policy
Seniors / Aging
Social services
Other
9
Professional skills* This field is required.Choose all that apply
Accounting / Finance
Fundraising / Development
Facilitation
Legal
Management
Marketing / Communications
Public speaking
Research / Data Analysis
Strategic planning
Other
10
Have you ever served on a nonprofit board of directors?* This field is required.
YESNO
11
Please share the name(s) of that nonprofit?This helps us better understand the kinds of organizations you might be interested in.
12
Does your employer donate to local nonprofits?* This field is required.
Yes
No
Unsure
13
Do you have a preferred location for meetings / events?* This field is required.
Alameda County (West)
Alameda County (East)
Contra Costa County (West)
Contra Costa County (Central)
Contra Costa County (East)
Virtual
No preference
Other
14
How much time can you approximately commit to board service?* This field is required.This may include things like regular board meetings, committee meetings, or major events.
1 hour / month
5 hours / month
10 hours / month
20+ hours / month
Unlimited time / month
15
How much of a monetary commitment would you consider as a part of board service?* This field is required.This can include personal contributions or funds you help raise from others.
No monetary commitment
Less than $250 / year
$250 - $500 / year
$500 - $1,000 / year
$1,000 - $2,500 / year
$2,500 - $5,000 / year
More than $5,000 / year
Unsure at this time
16
Do you consent to Engage East Bay sharing your contact information with local nonprofits to help facilitate a successful match?* This field is required.
YESNO
17
Anything else that you'd like to share?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: