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Exit Survey
 
 

The Male Engagement Network (MEN) is about making connections. We create safe spaces where men of color can come together to receive and give support, learn and teach, heal and be healed.  Our mission is to build pathways to success for men of color by focusing attention and resources on the social stressors that obstruct their potential: 1) financial health 2) housing stability, and 3) mental health.
 
 
 

The Male Engagement Network (MEN) is about making connections. We create safe spaces where men of color can come together to receive and give support, learn and teach, heal and be healed.  Our mission is to build pathways to success for men of color by focusing attention and resources on the social stressors that obstruct their potential: 1) financial health 2) housing stability, and 3) mental health.
 
Create your unique, personal code:
Example:
Name - John Doe
Birthday - 03/24/1987
Code = JOD0324
First two letters of First NameFirst letter of Last NameMonth of Birth (MM)Day of Birth
Personal Code
 
 
Name - (First/Last)
   
 
 
 
How did you hear about us?
   
 
 
 
The following questions will help us determine which resources would be most useful to you.
If you were to think about the goals you would like to accomplish in the next year, in which of the following areas would they fall? Check all that apply.
 
Finding affordable housing
 
Managing my finances
 
Finding mental health services
 
Building social connections
 
Finding a job
 
Completing my education
 
Finding immigration services
 
Finding parenting resources
 
Addressing legal issues
 
Finding medical care
 
Other
 

 
 
 
Are there resources you would like to share with the Male Engagement Network? Please list them here:
   
 
 
 
The following questions will help us learn more about the men participating in our events.
 
 
 
Phone Number:
   
 
 
 
Email:
   
 
 
 
ZIP code:
   
 
 
 
What is your date of birth?
MonthDayYear
  
 
 
 
Which of these categories best describes your racial/ethnic identity? Check all that apply.
 
African-American
 
Cape Verdean
 
African
 
Haitian
 
Hispanic or Latino
 
White (Non-Hispanic)
 
Asian
 
Multi-Racial
 
Middle Eastern
 
Native Hawaiian/Pacific Islander
 
Native American or Alaskan Native
 
Caribbean Islander
 
Other

 
 
 
What is your current relationship status?
 
Married, live together
 
Separated
 
Married, live apart
 
Single
 
Live-In Partner
 
Partnered, living seperately
 
Divorced
 
Widowed
 
 
 
What is the highest grade that you have completed?
 
Less than high school
 
Some college or vocational school
 
High school graduate/GED
 
College graduate
 
Vocational degree or certificate
 
Graduate school
 
 
 
I am:
Employed full time Employed part time Unemployed