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Demographic Survey · Recommended

Understand Who Your Nonprofit Programs Really Serve

Capture participant demographics, household size, and housing status in one easy survey that simplifies funder reporting and program planning.

Use This Template Free Preview

Teal theme

formbuilder.ai/f/nonprofit-program-participant-demographic-household-background-survey

Nonprofit Program Participant Demographic & Household Background Survey

Participant Name

· · ·

Date of Birth

· · ·

ZIP Code (where you currently li

· · ·

Submit

This participant demographic and household background survey gives your nonprofit a simple, respectful way to learn who your programs serve. It opens with a friendly privacy note explaining that responses are combined before being shared with funders. It then collects participant and program details such as name, date of birth, ZIP code, and primary program. From there, it covers personal demographics including gender identity, race and ethnicity, primary language spoken at home, education level, employment status, health insurance coverage, veteran status, and disability status.

The template is designed for nonprofits, community-based organizations, social service agencies, and grant-funded programs that need dependable participant data. A dedicated household background section captures total household size, number of children under 18, household type, and current housing situation. This gives case managers, program staff, and development teams the context they need to understand participant circumstances and spot service gaps.

Using a standardized online survey makes grant reporting faster and more accurate. Instead of piecing together paper forms and spreadsheets, you collect consistent, structured responses that are easy to aggregate for funder reports, board updates, and community needs assessments. Customize the answer options to match your funders' reporting categories, add or remove questions, and share the survey online or on a tablet during intake. Start with this free template today to better understand your community and plan services that truly meet participant needs.

3 Pages

19 Questions

~6min To complete

Free Included on every plan

Field types Dropdown ×9 Multiple Choice ×2 Single Choice ×2 number ×2 Full Name Date Short Text termsandconditions

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Participant & Program Information 4 questions

Participant & Program Information

Thank you for taking a few minutes to tell us about yourself. Your answers help us improve our programs and plan services that meet your needs. Your information is kept private. When we share results with funders, we combine everyone's answers so that no one can be identified.

1 Participant Name * Full Name

2 Date of Birth * Date

3 ZIP Code (where you currently live or stay) * Short Text

4 Primary Program You Are Enrolled In * Dropdown

Page 2 Personal Demographics 8 questions

Personal Demographics

1 Gender Identity * Dropdown

2 Race and/or Ethnicity (select all that apply) * Multiple Choice

3 Primary Language Spoken at Home * Dropdown

4 Highest Level of Education Completed * Dropdown

5 Current Employment Status * Dropdown

6 Primary Health Insurance Coverage Dropdown

7 Have you ever served on active duty in the U.S. Armed Forces? * Single Choice

8 Do you identify as a person with a disability? * Single Choice

Page 3 Household Background 7 questions

Household Background

1 Total Number of People in Your Household (including yourself) * number

2 Number of Children Under 18 in Your Household * number

3 Household Type * Dropdown

4 Current Housing Situation * Dropdown

5 Annual Household Income (before taxes) * Dropdown

6 Which benefits does your household currently receive? (select all that apply) * Multiple Choice

7 I understand that my responses are confidential and consent to their use for program planning, evaluation, and anonymous aggregate reporting to funders. * termsandconditions

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.