Chi-Rho Association

Chi-Rho Survey

Below is a survey of college or university affiliated or "college age" people who worship at various "off campus" parishes in Madison, Wisconsin. College/University students, faculty, and staff, regardless of age are invited and requested to participate, as are all persons of "college age" (approximately 17 to 40 years) regardless of affiliation.

If you encounter any problems in using this form, please contact Tom. Thanks for your time!

* indicates a required field.

Note: Note: Personal information collected at this site will not given, sold or otherwise distributed to third parties, except that contact information may be given to those (usually parish staff and volunteers) who run or co-ordinate any activities in which you may express an interest. Some contact information may be shared with the pastor or pastoral staff of the parishes which you list as attending, or with Catholic campus pastoral staff, if they request it. Student/staff ID numbers are never shared with any third party, and have been and are used solely to help maintain and organize our internal database.

Name First Name: *
Last Name: *
Middle Initial:
Gender:

Contact Information Phone:
Street Address:
Apartment:
City: State:
Email:
I would like to be on the event and information e-mail list.

May the Chi-Rho association include your basic contact information in a directory of people who have participated in this survey, to be distributed only to participants? Yes No

Marital Status Are you Single or Married?

Spouse's name:

School Information Student:
Where do you go to school?
What type of student are you?
What is your Department/Major?
When do you expect to graduate? (MM/YYYY)
What degree do you expect to receive?
What is your 10-digit StudentID (for our database):

Alumnus:
Where did you go to school?
What degree did you most recently receive?
When did you receive this degree? (MM/YYYY)
What was your Department/Major?
What is your former StudentID (for our database):

Work Information If not a student, where do you work?
What is your occupation?

Church Information What parishes/churches do you most frequently attend when in Madison?

1) 2) 3)

Personal Information What is your hometown?
Is there anything else you would like to share with us about yourself?

Activities Please check the activities below in which you might like to participate:

Classes
Classes in Catholic Doctrine
Classes for those interested in becoming Catholic
Classes in Liturgical Latin
Discussion or Study Group
Teaching Catechism (to children and young adults)

Social Events
Social Activities
Help Organize Social Activities

Campus Organizations
Perpetual Eucharistic Adoration
St. Vincent de Paul Society (service to the poor, elderly or imprisoned)
UW-Madison Knights of Columbus

Liturgy
Reading at Mass
Serving at Mass
Being an Extraordinary Minister of the Holy Eucharist
Music Ministry (Choir, Cantoring)
Being an Usher at Mass

Service Opportunities
Visits to Home-bound Parishioners
Visits to Nursing Home
Manual labor around parish (cleaning up, moving furniture, etc.)

Other
Right to Life
Participating in a retreat or day of reflection