We value your feedback.

Because of Moffitt’s transformational research, leading-edge treatments, and exceptional care, countless patients can now call themselves cancer survivors. But we can’t do it without you! The information we gather from supporters like you will help us in our urgent quest to make tomorrow’s breakthrough happen today.

Step 1 of 12

1) Has your life, or someone in your life, been touched by cancer?

Yes

Which type of cancer are you most concerned about?

2) In what ways have you interacted or engaged with Moffitt Cancer Center? Please select all that apply.

I am or have been treated, or participated in a clinical trial, at Moffitt.

A family member, friend or loved one is being treated or has been treated at Moffitt.

I am or have been employed by Moffitt.

I am a volunteer.

I have browsed Moffitt’s website and/or social media.

I have participated in event(s) such as Miles for Moffitt.

I have donated to Moffitt Cancer Center.

Other

2b) Ways of interaction or engagement - Other

Please specify:

2c) How recently have you been involved with Moffitt?

How recently have you been involved with Moffitt?

Within the past week

Within the past month

Within the past year

Within the past 1-5 years

Within the past 6-10 years

More than 10 years ago

Other

2c-a) How recently have you been involved with Moffitt -- Other

Please specify:

3) We like to send supporters like you occasional emails with updates including videos, stories, and information about how we are making an impact on your behalf. Would you like to receive these updates? (You can opt-out at any time).

Yes, I want to receive occasional emails with updates.

Not at this time.

4) Which aspect of Moffitt’s work is most important to you? Please select one:

Research – Making life-changing discoveries in the prevention and cure of cancer.

Patient Care – Providing leading-edge cancer treatment and exceptional care.

Education – Developing the next generation of oncology professionals as the only NCI-designated Comprehensive Cancer Center based in Florida.

Outreach & Awareness – Providing health education in the areas of prevention, early detection and screening.

Patient & Family Support – Helping patients and their families through all stages of treatment and survivorship.

5) Is there a person who inspired your interest in Moffitt Cancer Center?

Yes

5a) Please indicate this person’s relationship to you:

Please indicate this person’s relationship to you:

Spouse/significant other

Parent/grandparent

Child/children

Other family member

Friend

Moffitt doctor, staff or volunteer

Other

5a-b) Indicate this person’s relationship to you - Other

Please specify:

5b) If you wish, please tell us about this person:

If you wish, please tell us about this person:

6) How important is it to you that future generations have the opportunity to receive treatment and care at Moffitt Cancer Center?

Of the utmost importance

Extremely important

Somewhat important

Not very important

Not important at all

6a) If you feel comfortable, please share with us why you made this selection.

If you feel comfortable, please share with us why you made this selection.

7) We are so inspired by our Moffitt Cancer Center supporters. Would you consider joining them by supporting us in the following ways?

I give this way now	Likely	Somewhat likely	Not likely

Mailing a check

I give this way now

Likely

Somewhat likely

Not likely

Donating online with a credit card

I give this way now

Likely

Somewhat likely

Not likely

Making a tribute gift in honor or memory of a loved one

I give this way now

Likely

Somewhat likely

Not likely

Donating from my donor-advised fund or family foundation

I give this way now

Likely

Somewhat likely

Not likely

Giving appreciated assets such as stocks, bonds, savings accounts, CDs, securities, etc.

I give this way now

Likely

Somewhat likely

Not likely

Making a gift from my IRA

I give this way now

Likely

Somewhat likely

Not likely

Talking with a gift officer face-to-face or by telephone

I give this way now

Likely

Somewhat likely

Not likely

Making a gift that provides me with income

Read about income gifts

Life income gifts provide philanthropic support for Moffitt while also providing both an income stream and charitable income tax deduction to you and/or your loved ones.

I give this way now

Likely

Somewhat likely

Not likely

Making a gift to name a room or facility at Moffitt

Read about naming opportunities

Moffitt Cancer Center is proud to offer naming opportunities throughout the institution as a way to honor or memorialize a loved one, show gratitude to a caring physician, or commemorate a special occasion in a thoughtful way. By naming a room or facility at Moffitt, you can leave a permanent mark on the institution and provide hope for other patients.

I give this way now

Likely

Somewhat likely

Not likely

Do you have a donor-advised fund or family trust/foundation?

Yes

8) Many people have left a gift in their will or trust to an organization that has been meaningful to them. Have you considered making this type of gift to Moffitt?

I have already left a gift for Moffitt in my will or trust, or by beneficiary designation such as life insurance or retirement assets.

I am interested in making this type of gift to Moffitt.

Not now, but in the future I would definitely be interested in making this type of gift to Moffitt.

Not now, but in the future I might be interested in making this type of gift to Moffitt.

I will never be interested in this type of gift.

8a) Please tell us about your gift:

Please tell us about your gift:

I planned this gift in honor or in memory of someone.

I intended this gift for a specific purpose.

Moffitt Cancer Center Foundation may use this gift where needed most.

8a-a) I planned this gift in honor or in memory of someone - Please provide name or association with this person

Please provide name or association with this person:

8a-b) I intended this gift for a specific purpose - Please provide the intended purpose

Please provide the intended purpose:

8b) Please send me additional information to help with my decision. I would like the following resources:

Please send me additional information to help with my decision. I would like the following resources:

Your Moffitt Legacy...Curing Cancer®

Build a Lasting Legacy

Gifts in a Will: Create a Legacy of Life with Moffitt Cancer Center

Gifts by Beneficiary Designation: Your Legacy Could Be a Cure for Cancer

Gifts That Pay You Income

Make an Impact with Your Donor Advised Fund

Tax-Wise Ways to Find a Cure with Moffitt

8c) Comment

Comment

9) How does Moffitt Cancer Center rank compared with other charities you may support?

My top choice for charitable giving

Near the top of my list

Middle of my list

Bottom of my list

Not on my list

9a) Do you have any friends, colleagues or family members with similar interests who would consider supporting the mission and vision of Moffitt Cancer Center?

Do you have any friends, colleagues or family members with similar interests who would consider supporting the mission and vision of Moffitt Cancer Center?

Yes

9a-i) Please let us know the most convenient way to connect:

Please let us know the most convenient way to connect:

I would be happy to personally introduce Moffitt to this person. Please contact me.

I would like to share information about Moffitt with them on my own; please provide that for me.

10) If your life or someone in your life has been touched by cancer, would you mind sharing your story with us?

11) About You (optional)

Age

Under 40

40 - 49

50 - 59

60 - 69

70 - 79

80 - 89

90+

Gender

Male

Female

Prefer not to specify

What is your marital status?

Married

Not married

Widowed

Which of the following best describes your family?

I do not have any children.

I have one child.

I have two or more children.

Which of the following best describes your highest education level?

High school or equivalent

Some college

Associate’s degree

Bachelor’s degree

Advanced degree

Please select the option(s) that best describe your professional life (select all that apply).

Working full time

Working part time

Retiring within 5 years

Retired

Active volunteer

Board member for a nonprofit

Self-employed

Other

Professional life - Other

Please specify:

Profession:

Where do you serve as a board member?

Please check the box below if you would like to update your contact information.

I’d like to update my contact information.

First Name(Required)

Last Name(Required)

Address

Address 2

City

State

Zip

Country

Phone number

Email(Required)

Comments

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