Avanse Ansanm Listening Campaign Survey 
Please complete the following survey to help Avanse Ansanm build community and identify our community's concerns and priorities.
Sign in to Google to save your progress. Learn more
​​What issues impacting the Haitian-American community do you care about so much that you are willing to get involved if asked?
When thinking about issues in our community rank the following from most critical  (1) to least critical (7).
1
2
3
4
5
6
7
Advocacy & Political Power
Arts & Cultural Preservation
Economic Opportunity & Employment
Education & Youth Development
Elderly Services
Health & Environment Issues
Housing
Clear selection
What gifts, skills, and abilities are you willing to share with our community?  
​​What personal and/or professional development opportunities do you want made available to you?
What programming would you like to see from Avanse Ansanm?
What county do you live in? *
What industry do you work in? *
Date of birth *
MM
/
DD
/
YYYY
What's your annual income range?
Clear selection
What is your current marital status? *
Will you commit to telling people about Avanse Ansanm and the work we're doing? *
Any additional feedback? *
Full Name (optional)
Email Address (optional)
Phone Number (optional)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Santra Denis. Report Abuse
Google Forms