Please complete the survey questions below to enter your name into the lap top
computer raffle. Each name is entered once so individual should not complete this
survey more than once. The prize will be presented at the event at CCNY on
June 12th (must be at the event to win).



1. How did you hear about the CCNY Bridging Community and Education event?
Flyer
Email
CCNY Website
Radio/ Television
Other:

2. Age:
14 to 21
22 and Older

3. Gender:
Female
Male

4. Ethnicity:
Black
Hispanic
White
Asian
Other:

5. Is this your first time to CCNY?
Yes
No


6. If yes, do you visit the campus:
Weekly
Monthly
Annually
Never/ Hardly ever


7. Are you enrolled in any program at CCNY?
Yes
No


8. If yes, please list all CCNY programs in which you have participated:


9. Do you know about CCNY's college preparation programs for high school students?
Yes
No


10. Do you know about CCNY adult continuing Education Program?
Yes
No


11. What schools or community based organization are you affiliate with:



12. Does your organization have a partnership with CCNY academic enhancement programs?
Yes
No


13. How can CCNY provide the people in the community with information about all of its resources?


14.
Zip:

15.
Name:
E-Mail: