CNC Member Demographics 2023
As a non-profit agency that relies on community, corporate, and foundation support, the below information is required from all individuals who wish to utilize the Career & Networking Center's resources as a member. Please note, the reports generated are on the collective demographics of our members, therefore, your personal information will not be shared with any third party that would identify you with specific responses. Thank you!
Membership Date
*
-
Month
-
Day
Year
Date
Client Name
*
First Name
Last Name
Client E-mail
*
example@example.com
Client Phone (Cell Preferred)
*
Client Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Township
*
Please Select
Lisle Township
Naperville Township
Wheatland Township
Unsure
N/A
County(Illinois Residents)
*
Please Select
Cook County
DuPage County
Will County
Kane County
N/A
Employment Status
*
Please Select
Employed
Unemployed
Underemployed
Birthdate
*
-
Month
-
Day
Year
Date
Gender
*
Ethnicity
*
Please Select
White (Caucasian)
African American/Black
Asian/Pacific Islander
Hispanic
Native American
Other
Marital Status
*
Please Select
Married
Single
Head of Household
*
Yes
No
Number of individuals in Household
*
Current Total Household Income
*
Recent High School or College Graduate (Within the last 2 years)
*
yes
no
List Name of High School/College w/City & State
If you are a recent graduate (within 2 years), you must list school above for discount.
Military Veteran
*
Yes
No
How did you hear about us?
*
Please Select
Agency/Business
Family/Friend
Social Media
Agency/Business
Google/Internet Search
Other
If referred by an agency or business, please share name.
*
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CNC Membership
$
100.00
Credit Card
Please check your email upon completion, for our mandatory Member Agreement Form.
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