Copy of LevelUp Kids Feasibility Study Survey
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
3.
In what ways have you been involved in LevelUp Kids?
Donor
Community Leader
Board Member
Institutional Funder
Other (please specify)
4.
How familiar are you with the work/mission of LevelUp Kids?
5.
Are you confident that these leaders make wise decisions regarding the direction and operations of LevelUp Kids?
Extremely confident
Very confident
Somewhat confident
Not so confident
Not at all confident
Comments
A CAMPAIGN FOR LEVEL UP KIDS
In addition to their school-based outreach, LevelUp Kids currently has separate offices for their dental and vision programs. As demand for their services grows LevelUp Kids must consider options for future office space to accommodate both their vision and dental programs. The new office space would include:
· 8 dental exams rooms, one specifically for sedation and necessary surgeries
· 2 optometry exam rooms
· Optical room for selection and fitting of eye glasses
· Secure parking for the service delivery vans
· Conference/multi-use room
· Space for partnerships with local social service agencies to provide a food pantry, hearing screenings and a wellness program
6.
Do you support these investments and feel like they advance the mission of LevelUp Kids?
Very Supportive
Somewhat Supportive
Neutral
Not Supportive
Not at all Supportive
Comments
7.
Do you have any questions about the potential project?
8.
The cost of LevelUp Kids proposed investments for the project could potentially total $5 Million. Do you think the proposed goal is attainable?
Very Attainable
Somewhat Attainable
Neutral
Not Attainable
Not at all Attainable
Comments
9.
Do you think our community would respond positively to a campaign for these initiatives?
Quite Positive
Somewhat Positive
Neutral
Not Positive
Not at all Positive
Comments
The table below represents the likely size and number of charitable gifts needed to complete the new building.
10.
If LevelUp Kids held a capital campaign of this size, do you believe there are individuals, businesses, or foundations that have the ability to give these kinds of gifts to LevelUp Kids?
Yes
No
Comments
11.
To whom would you look for the top three largest gifts to a potential LevelUp Kids campaign?
12.
Who do you think are the most important people in the community who should be involved in the Campaign?
13.
Would you be willing to help LevelUp Kids plan and/or implement a possible Capital Campaign? (If so, please provide your name and contact information.)
Yes
No
Name and Contact Information
14.
If LevelUp Kids held a capital campaign within the next 12 months would you consider making a pledge?
Yes
No
Unsure
15.
Is there a level on the above chart that reflects the size of a capital gift your family/business/foundation might consider pledging over 3 years? If so, please list the amount below.
(This gift would be over and above any annual support you offer to LevelUp Kids. The level you share today is not a commitment.)
16.
What would you expect your network (family, friends) could contribute?
Less than $2,500
$2,500 - $5,000
$5,000 - $10,000
$10,000 or above
Other (please specify)
17.
What factors do you feel may prevent LevelUp Kids from conducting a successful Capital Campaign?
18.
Are there any other comments, suggestions, or questions you would like LevelUp Kids to consider?
