1

Enter the Zip Code for where you live now* This field is required.

2

Gender at Birth

Male

Female

4

What type of Retirement Living are you interested in(Mark all that apply)

Independent Living

Independent Living with some assistance

Assisted Living

24-Hour Care

Memory Care

5

The statement: “An Agri-Village where people of faith will grow in the Spirit.” means…

It’s a Christ-centered community

It has a Biblical Worldview

It’s faith-based

It’s a place where I will live in common fellowship

Other

6

What G3 Village volunteer service are you willing to perform?(Mark all that apply)

Planting, Tending & Harvesting Crops

Feeding & Tending Animals, Collecting Eggs

Building Maintenance & Cleaning

Grounds Management

Hospitality Service

Office Assistance

Kitchen or Dining Room Service

Serving on a School Field Trip

Serving in a Thrift Store

7

10. What does Agri-Village eating mean to you?(Mark all that apply)

Organic (Fruits & Vegetables)

Whole food (Non-Processed Food)

Meats & Cheese

Breads & Pastas

Candy, Cakes, Pies (Sweets)

Alcohol

8

How many volunteer hours are you willing to contribute each week?

None

up to 10

11 – 20

Over 20

9

Would you like to continue with more questions or submit the form?

Continue with more questions

Submit the form

10

What is the current cost in your area for a one-bedroom suite with fresh whole food and utilities included:

$2,250

$2,500

$2,750

$3,000

$3,250

12

Which state would you like to see the G3 Village located?

13

What skills would you bring to the G3 Village(Mark all that apply)

Planting, Tending & Harvesting Crops

Feeding & Tending Animals, Collecting Eggs

Building Maintenance & Cleaning

Grounds Management

Hospitality Service

Office Assistance

Kitchen & Dining Service

Serving in a Doggie Daycare, Thrift Store and Events

Other

14

What skills would you bring to the G3 VillageJust enter anything you can do that you think would be useful at a G3 Village

15

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