1. Have you utilized the services of the African American Community Service Agency?

Yes ___ No ___

If Yes, what services have you used? 

___    Computer Literacy Training 
___    Juvenile at Risk 
___    Homeless Breakfast 
___    Senior Christmas Luncheon 
___    Senior Brown Bag Program 
___    Summer Day Camp Program 
___    The Inez Jackson Black Historical Research Library
___    Juneteenth Festival 
___    Housing Assistance Program 
___    Referral Program 
___    Job Club

_____________________________________________________________________________
 

3. What services/and or Programs can you donate to the African American Community Service Agency?

        Teacher ______________________________________________________________

        Counselor ____________________________________________________________

        Volunteer ____________________________________________________________

        Other ________________________________________________________________
 
 

4. Would you like to donate monies to the African American Community Service Agency? 

Yes ___ No ___

If Yes, to ___    New AACSA Cultural Center
               ___     Computer Program 
               ___     Referral Program 
               ___     Juneteenth 

Other, see programs and services above. _______________________________________________________________