Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please review, and if you agree, place a checkmark beside both statements.* *

I agree to invite my neighbor households to a gathering to get to know one another better.

Upon request, I will share how the gathering went with Equal UA, UA Community Foundation, and the Center for HumanKindness.

The Porch Party kit includes materials to make hosting your gathering easier, like invitations and name tags. If you expect children to attend, we can include sidewalk chalk too! Please let us know if you would like sidewalk chalk + bubbles included in your kit.* *

Yes, please include sidewalk chalk + bubbles in my kit.

No, I don't need sidewalk chalk + bubbles in my kit.

When (or approximately when) do you plan to host your party? *

MM

DD

YYYY

How connected do you currently feel to your neighbors? Rate your answer on a scale from 1 to 7, where 1 means you've never met your neighbors and 7 means you feel strongly connected to them. *

1 (I have never met my neighbors)

2

3

4

5

6

7 (I feel strongly connected to my neighbors)

Can we add you to the email list for the Center for Humankindness’s and Equal UA’s monthly newsletters?

Yes

No