Census – English

Please fill the form Just one time per Family.

**The data collected through GCNA Census program is securely protected and strictly utilized for internal purposes only.

1. Are you 18 years or older?*
YesNo

2. Zip code*

3. Phone Number

4. What is your gender?*
MaleFemaleOther

5. Number of MALE adults in the household - How many male adults in your household, including yourself and are 18 years and older?

6. Adult MALE age groups
18 - 2930-4041-5051-6060 +

7. Number of FEMALE adults in the household - How many female adults in your household, including yourself and are 18 years and older?

8. Adult FEMALE age groups
18 - 2930-4041-5051-6060 +

9. Number of MALE children in the household - How many male children in your household?

10. MALE Children age groups
0-4 Years5-10 Years11-1314-18

11. Number of FEMALE Children in the household - How many female children in your household?

12. FEMALE children age groups
0-4 Years5-10 Years11-1314-18

13. Your Marital Status*
MarriedSingleDivorcedWidowedSeparatedNever MarriedLiving with Partner

14. Highest grade you completed?*
Less than high schoolHigh schoolSome college or technical schoolBachelor's degree or higher

15. Do you own or rent your home?*
OwnRentOther arrangement

16. Are you US Citizen?*
YesNo

17. Country of Origin?

Nepal

Other

If other, please enter country of origin:

Membership Form

18. Are you a GCNA member?

If you are interested in becoming GCNA Member. Please click here .

19. When did you move to Greater Charlotte Area? (Year)

20. What are your areas of interests (hobbies)*

21. Please provide any feedback/suggestions to GCNA.

Δ