Collective Contribution Form English

1
First of all: Are you interested in being a part of our collective?* This field is required.There's no right or wrong answer! You do not have to be a Collective member to be part of The Rainbow FRC.
Yes
Maybe?
No
2
Joining our collective is completely optional. If you're not sure about joining but want to learn more, keep going. No pressure! This quiz is not an application or commitment
Keep going
I'm done
3
Awesome, let's get started! Keep answering questions so we can help you determine the right membership style for your needs and recommend a membership contribution that fits your budget. You will have the option to provide contact information at the end if desired.
Keep going
4
Are you over the age of 18?If you're a parent representing a child under the age of 18, the membership will be a family membership. Minors do not qualify for an individual collective membership, but they qualify for our youth leadership program! Select "no" below to skip the rest of the questions and learn more about youth leadership.
Yes
No
I'm an emancipated minor
We are a family with at least one member over 18
We are an organization or business
5
What best describes your role with the Rainbow FRC?Please select the option that best describes you. It's okay if it's not a perfect fit!
Individual seeking or receiving services
Family seeking or receiving services
Volunteering part-time
Volunteering significant time or specialized skills
Paid employee
Founding member or leadership
Business or organization seeking or engaging in a partnership
6
How many hours per month do you volunteer?
10 or less
10-25
25-40
40 or more
7
How large is your family?
Just me
2 people
3-5 people
5-10 people
10 or more people
8
Does your household qualify as "low income" by the Santa Cruz Housing Authority?1-person household: $92,200 or less 2-person household: $105,350 or less 3-person household: $118,550 or less 4-person household: $131,700 or less 5-person household: $142,250 or less 6-person household: $152,750 or less 7-person household: $163,250 or less 8-person household: $173,750 or less 9-person household: $184,300 or less 10-person household: $194,800 or less
Yes, my household is considered low-income
No, my household is not considered low-income
9
Do you use any of the following services to make ends meet?Select all that apply
Medi-Cal, Medicaid, CCAH, CHIP or another public healthcare assistance program
Cash aid, TANF, unemployment, disability, or other financial assistance
Food stamps, SNAP, WIC, EBT, or other food assistance
Food pantries, food banks, essentials distribution, or other free or low-cost distribution of goods
Section 8 or housing vouchers, public housing, homeless shelter or domestic violence shelter, or another housing support program
Subsidized childcare, head start/early start, preschool vouchers, or other childcare support programs
Job training or career services
Public transportation assistance, gas or car repair assistance, or other travel-related programs
Other faith-based or community-based assistance programs
None of the above
10
Do you face any of the following obstacles?Select all that apply
Reduced ability to work due to disability or developmental needs
Reduced ability to work due to caring for a disabled loved one
Reduced ability to work due to school enrollment
Additional financial constraints due to medical expenses or other care-related expenses
Lack of access to transportation
Temporary or long-term homelessness
Recent or current domestic violence
Recent jail or prison release
History of or current incarceration
None of the above
11
Approximately how much money does your household have available at the end of each month?Do not include any funds set aside for necessities such as rent or housing, emergencies, bills, food, transportation, medical expenses, or ongoing savings goals.
$0-$100
$101-$300
$301-$700
$701-$1500
$1500+
12
Thank you for your interest in strengthening your partnership with The Rainbow Family Resource Center! We're excited to work with you. All businesses and organizations fall under partner memberships in our collective. Keep answering questions so we can help a membership contribution that fits your budget. You will have the option to provide contact information at the end if desired.
Keep going
13
How many employees would utilize your collective membership?
1-5
5-10
10-20
20 or more
14
What type of business or organization is this?
Non-profit organization
For-profit, fiscally sponsored organization
For-profit business
Local, state, or federal government agency
15
What is your primary source of income?Select all that apply
Sales and/or Services
Donations and/or Grants
Vendorship and/or Contracts
Views and/or Followers
16
What is your organization's average monthly income?
$1000 or less
$1,001-$5,0000
$5,001-$10,000
$10k or more
$20k or more
17
Would you like your contribution to help cover costs for other families in need?
Yes
No
18
Would you prefer to contribute monthly or annually?
Monthly
Annually
19
Would you like to be contacted about your form submission?This is completely optional. Either way your results will pop up as soon as you hit submit.
Yes, please contact me
No, leave me anonymous
20
First and Last Name (And organization name, if applicable)If you would like to remain anonymous, please leave this blank!
21
Email address
example@example.com
22
Phone Number
Please enter a valid phone number.
23
Your Suggested Contribution is $:
Should be Empty: