1. What areas of our work matter most to you? (Please check all that apply)
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Cancer & Chronic Diseases
Child Health
Community Health Workers
Maternal Center of Excellence
Tuberculosis
Women's Health
Other
2. What inspires you to support Partners In Health Canada?
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A personal experience with global health
A passion for advancing global health
A belief in ensuring every person receives the best possible care
In honour of a loved one
Other
3. How can PIH Canada improve the way we communicate with you? (Please select all that apply.)
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More emails
Fewer emails
Electronic newsletters
Information sessions or webinars
Reading club
A phone call
SMS text
Other
4. Do you feel adequately informed by PIH Canada about how your donations are making a difference in the communities we serve?
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Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
5. What are the top 3 charities you support?
*
6. Have you ever considered leaving a gift in your Will to support Partners In Health Canada?
*
Yes, I have already included PIH Canada in my Will
No, but I would like more information
Not interested at this time
7. In the coming months, we will be looking for leaders interested in transformative healthcare projects that you may want to be a part of. We are looking for leaders to make gifts of $500 and up to inspire and encourage others to donate. Are you able to consider such a gift in the coming months?
*
$500 - $999
$1,000-$2,499
$2,500 - $4,999
$5,000 - $10,000
More than ten thousand
Not interested at this time
8. We’d love to know when your birthday is. We enjoy celebrating our supporters! (Optional)
Please select a month
January
February
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Please select a day
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Please select a year
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9. What stage of your career are you in?
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Entry Level
Junior
Senior
Leadership
Retired
10. What industry do you work in?
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Healthcare
Tech
Government
Finance
Retail
Other
11. What is your household income?
*
<$56,999
$57,000-$114,999
$115,00-$252,999
$253,000+
Prefer not to answer
12. What local or online sources do you use for news and information? (Optional)
13. Full Name
*
14. Email
*
15. As a thank you for your time, you can choose to enter for a chance to win 1 of 3 $20 Indigo e-gift cards. Entry is completely optional—just our way of saying thanks!
*
Yes, enter me in the draw
No, submit answers without entering the draw
Please verify that you are human
*
Submit
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