We value your feedback

As a loyal supporter of the ALS Network, your experiences and feedback are valued.

Step 1 of 12 - Q1

1) Do you believe in the ALS Network's mission to discover treatments and cures for ALS, and to serve, advocate for, and empower people affected by ALS to live their lives to the fullest?

Yes

2) In what ways have you engaged with the ALS Network? Please select all that apply.

I donate to the ALS Network.

A friend or family member receives care and support from the ALS Network.

I have ALS and receive care and support from the ALS Network.

I am a current or former employee of the ALS Network.

I have attended the ALS Network's events.

I have organized an ALS Network fundraiser.

I follow on social media.

I have visited the website.

Other

2a) Other - Please specify:

Please specify:

2b) How frequently do you engage with the ALS Network?

How frequently do you engage with the ALS Network?

Weekly

Monthly

Every few months

Yearly

Rarely or never

Other

2b-i) Other - Please specify:

Please specify:

2b-ii) If you're not already engaged, in what ways would you like to engage with the ALS Network?

If you're not already engaged, in what ways would you like to engage with the ALS Network?

Become a donor.

Attend events of the ALS Network.

Organize an ALS Network fundraiser.

Follow the ALS Network on social media.

Visit the ALS Network website.

Other

2b-iii) Other - Please specify:

Please specify:

3) We like to send supporters like you occasional emails with updates including videos, stories, and information about how we are making an impact on your behalf. Would you like to receive these updates? (You can opt out at any time).

Yes I want to receive occasional emails with updates.

Not at this time.

4) Which aspects of the ALS Network's work are most meaningful to you?

Please rank the following according to their importance to you, with First Priority being your highest priority.

You may only select one answer for each option.

First Priority	Second Priority	Third Priority	Fourth Priority

Care Services – Our unique wraparound model of care combines fully coordinated, individualized medical care with essential community-based care services, all at no charge to the ALS community. Care services are designed to help people live longer and better with ALS and to accelerate the search for cures.

First Priority

Second Priority

Third Priority

Fourth Priority

Advocacy – The ALS Network leads advocacy efforts to promote important public policy initiatives that improve the lives of those living with ALS and accelerate ALS research.

First Priority

Second Priority

Third Priority

Fourth Priority

Research – In partnership with a world-renowned scientific advisory committee, the ALS Network funds and supports the most promising peer-reviewed research and novel endeavors designed to accelerate the search for effective prevention strategies, treatments, and cures for ALS. To drive progress in the field, we connect the ALS community with ALS research projects.

First Priority

Second Priority

Third Priority

Fourth Priority

Community Outreach – The ALS Network hosts celebratory and meaningful gatherings to foster connection and empower individuals while raising funds, increasing ALS awareness, and creating help and hope in support of the ALS community.

First Priority

Second Priority

Third Priority

Fourth Priority

5) Was there an influential person in your life who inspired your appreciation of the ALS Network?

Yes

5a) If yes, please indicate their relationship to you.

If yes, please indicate their relationship to you.

Parent/grandparent

Spouse/partner/significant other

Child/children

Other family member

Friend

Teacher or professor

Other

5a-i) Other - Please specify:

Please specify:

6) When thinking about future generations, how important is it to you that the ALS Network continues to serve the ALS community?

Of utmost importance

Very important

Somewhat important

Not very important

Not important at all

7) Supporters often recognize the need to help the ALS Network in our efforts to discover treatments and cures for ALS, and to serve, advocate for, and empower people affected by ALS to live their lives to the fullest. Would you consider furthering our work in any of the following ways?

I already have	I am likely	I am somewhat likely	I am not likely

Donating online with a credit card

I already have

I am likely

I am somewhat likely

I am not likely

Mailing a check

I already have

I am likely

I am somewhat likely

I am not likely

Scheduling a visit or call with the Development team to discuss opportunities to make a substantial impact

I already have

I am likely

I am somewhat likely

I am not likely

Making a recurring contribution

I already have

I am likely

I am somewhat likely

I am not likely

Donating from a Donor-Advised Fund

I already have

I am likely

I am somewhat likely

I am not likely

Donating from a Family Foundation

I already have

I am likely

I am somewhat likely

I am not likely

Giving appreciated assets (such as personal or business stocks or bonds, land or rental real estate)

I already have

I am likely

I am somewhat likely

I am not likely

Giving property (such as jewelry, artwork or a car)

I already have

I am likely

I am somewhat likely

I am not likely

Transferring a portion of my IRA account (Qualified Charitable Distribution)

I already have

I am likely

I am somewhat likely

I am not likely

Making a charitable gift that provides a lifetime income to me or my loved ones

I already have

I am likely

I am somewhat likely

I am not likely

8) Many people like to include a gift to charity in their will or estate plan to support causes that are important in their life. Would you consider including a gift to the ALS Network?

I have included a gift for the ALS Network in my will, trust, or by beneficiary designation.

I am interested in making this type of gift to the ALS Network.

Not now, but in the future I would definitely be interested in making this type of gift to the ALS Network.

Not now, but in the future I might possibly be interested in making this type of gift to the ALS Network.

I am not interested in this type of gift.

8a) Please tell us about your legacy gift:

Please tell us about your legacy gift:

I planned this gift in honor or in memory of someone.

I would like this gift to go to a specific purpose.

The ALS Network may use this gift where it will do the most good.

8a-i) Please provide the name of and/or association with this person:

Please provide the name of and/or association with this person:

8a-ii) Please describe the intended purpose:

Please describe the intended purpose:

Please send me the following additional information to help with my decision:

Smart Ways to Make an Impact Now

Tax-Wise Ways to Make an Impact

Gifts That Pay You Income

Making an Impact With Your Donor-Advised Fund

A Simple Guide to Creating or Updating Your Estate Plans

Please send me more information about the mission priorities of the ALS Network:

Care Services. Helping people live longer and better with ALS.

Advocacy. Promoting important public policy initiatives to improve the lives of those living with ALS and to accelerate ALS Research.

Research. Funding the most promising research, while inspiring and initiating unique partnerships across all sectors.

Public Education & Awareness. Providing information and connection for those battling this devastating disease.

9) How does the ALS Network rank in comparison to other non-profits you may support?

My top choice for charitable giving

Near the top of my list

Middle of my list

Bottom of my list

Not on my list

9a) Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of the ALS Network?

Do you have any friends/colleagues/family members with similar interests who would consider supporting the mission and vision of the ALS Network?

Yes

9a-i) Please let us know the most convenient way to connect:

Please let us know the most convenient way to connect:

I would like to introduce the person(s) to the ALS Network on my own.

I would like the ALS Network to provide me with resources to share with the person(s).

10) We would love to hear your story. If you would like, please share a special memory or experience with the ALS Network.

11) About You (optional)

Age

Under 40

40 - 49

50 - 59

60 - 69

70 - 79

80 - 89

90+

Gender

Male

Female

Other/Nonbinary

Prefer not to specify

Please specify:

What is your marital status?

Married

Not married

Divorced

Widowed

Which of the following best describes your family?

No children

One child

Two or more children

Please tell us the highest level of education you completed:

High school graduate or equivalent

Some college

Associate's degree

Bachelor's degree

Advanced degree

Please select the option(s) that best describes your professional life.

Working full time

Working part time

Retiring within 5 years

Retired

Volunteering

Business owner or entrepreneur

Self-employed

Unemployed

Disabled

Board member for a nonprofit

Where do you serve as a board member?

Please specify your profession:

Please check the box below if you would like to update your contact information.

I would like to update my contact information.

First name(Required)

Last name(Required)

Address

Address 2

City

State

ZIP

Country

Phone

Email(Required)

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