ProjectPAL

ProjectPAL

OPALCO Account Number*

Member Name*

Email*

Home Phone

Work Phone

Street Address

VOLUNTARY Demographic Information

Why do we ask? This information helps us access grants and other funding opportunities to better serve you!

Veteran?

YES

NO

Disabled?

YES

NO

Gender

Male

Female

Transgender

Not singularly male or female (e.g., non-binary, gender fluid, a-gender, culturally specific identity)

Doesn’t Know/Questioning

Prefer not to answer

Other

Race and Ethnicity

White/Caucasian

Hispanic/Latina/o/x

Black/African-American/African

Asian, Asian-American

Native Hawaiian/Pacific Islander

Middle Eastern, North African

American Indian, AK Native, Indigenous

Prefer not to answer

Other

Highest Level of Education

Some school

High School Diploma

GED

Some College

Associate Degree

Vocational Certification

Bachelor’s Degree

Graduate Degree

Other

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