Alumnx Info needed for Free Foundwork Account

Thank you for contacting us to receive your free code for a Foundwork profile. Simply provide us with some basic info about your Centrum residency affiliation and you'll receive the code at the end of the survey!

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* 1. What year(s) were you, or might you be a Centrum resident? (please list approximate if you can't remember)

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* 2. Contact info (we are trying to update our files!)

First Name *

Last Name *

City/Town

State/Province

ZIP/Postal Code *

Country *

Email Address *

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* 3. Would you be willing to contribute stories about your time at Centrum in preparation for our upcoming 50th Anniversary?

Yes

Other (please specify)

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* 4. What do you think is the most important thing Centrum can do to support residents in today's new COVID-19 reality and moving forward?

Demographics - These questions help us understand more about who our programs are reaching and also help us submit statistics for grant purposes.

Alumnx Info needed for Free Foundwork Account

Question Title

* 1. What year(s) were you, or might you be a Centrum resident? (please list approximate if you can't remember)

Question Title

* 2. Contact info (we are trying to update our files!)

Question Title

* 3. Would you be willing to contribute stories about your time at Centrum in preparation for our upcoming 50th Anniversary?

Question Title

* 4. What do you think is the most important thing Centrum can do to support residents in today's new COVID-19 reality and moving forward?

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* 5. How do you describe your gender? (optional)

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* 6. How do you describe your racial, ethnic, or tribal identity? (optional)

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* 7. Is there anything else you'd like us to know?