Signup Form for Interview w/Catalyze SV on Technology & Community Engagement 
  • If you want to fill this form in language you are comfortable with, use Google Chrome
  • Right Click and choose the language. (If you will need translator, please specify in last question)
  • The interview will be to understand how technology can be used to improve community engagement and build tools for the community members.
  • This pre-survey is required if you'd like to participate in a 1-hour interview in-person or Zoom with Catalyze SV staff. It helps us ensure we have a diverse group of participants to interview. 
  • Upon completion of the 1-hour interview & short survey, you'll receive a $40 gift card of your choice.
  • Interviews are voluntary, and you can opt out at any time for any reason. Survey responses and interviews will be kept anonymous & only used for Catalyze SV's work on technology improvements.
  • This survey should take you about 3 minutes to fill out. 
We will contact you and schedule date, time and location as per your convenience. (Virtual or in-person)

For questions, please contact Shalini Gupta at shalini@catalyzesiliconvalley.org and/or (408) 930-4150

Email *
First and Last Name *
Do you own a cell phone? *
Cell Phone Number (If you do not own a cell phone, say "No") *
Personal Email (if you don't use one, say "No") *
Preferred Method of Communication *
Can you attend the session on  (6:30 - 8 pm)? *
Age Range *
Gender *
Which city do you live in? *
Which race or ethnicity do you associate with? (Select up to 4) *
Required
Primary languages spoken at home? (Select up to 3) *
Required
Do you have internet access (WiFi) where you live? *
How did you hear about this survey / what organization are you affiliated with?  *
Level of Education? (optional)
Clear selection
Housing Status? (Rent, Own, Unhoused - optional)
Currently Employed? (optional)
Any other information you would like to share about how you communicate, such as Language/Vision/Hearing/Accessibility Challenges (optional)
Thank you for filling the survey. Catalyze SV will contact you and schedule a date, time and location that works for you.

If you have questions, please email shalini@catalyzesiliconvalley.org or call (408) 930-4150.
A copy of your responses will be emailed to the address you provided.
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