Northwest Indiana

African American Alliance, Inc.

Northwest Indiana African American Alliance Inc
1001 Sturdy Road
PO Box 497
Valparaiso, IN 46384
United States
NWIAAA2013@yahoo.com

Click to enter an introduction to your survey here.

Hint: You can customize any form by editing the labels for each element, or by adding or deleting elements.

First Name:

Last Name:

Address Line 1:

City:

ZIP/Postal Code:

Email:

Mobile Phone:

Home Phone:

Ethnicity

Contact Preference:

How long have you lived in Northwest Indiana?

Less than 5 years 5 to 10 years 10 to 15 years More than 15 years

Housing

Rent Own

What is your occupation?

Are you employed in or around Northwest Indiana? If so, for how long?

Do you have children who attend school in Northwest Indiana?

If so, Where?

Have you or your child ever been treated unfairly within the school system in Northwest Indiana?

If so, when? Can you explain what briefly happened?

Has your child ever been expelled or suspended from school?

If so, why?

Do you feel your child was suspended or expelled unfairly?

Why or why not?

Has your child ever been bullied in school?

If so, have you contacted anyone? If so, who? Was your problem resolved?

May we add you to our Newsletter list?

Would you be willing to participant in a Parent Advisory Committee ?

Submit Your Message:

Northwest Indiana African American Alliance Inc
1001 Sturdy Road
PO Box 497
Valparaiso, IN 46384
United States
NWIAAA2013@yahoo.com