<p> St. Andrew AME Church 2009 Census (Please Print)</p><p>Name: </p><p>______</p><p>Email Address: ______</p><p>Home Phone: ______Cell Phone: ______</p><p>Address: ______</p><p>City: ______State: ____ Zip: ______</p><p>Birth Date: ___/___/____ </p><p>Occupation: ______Employer: ______</p><p>Please circle your answer to the following: (a) Are you Head of Household: Yes or No (b) Gender: Male or Female (c) Primary Service: 7:45am or 11:00am (d) Marital Status: Single/ Married/ Separated/ Divorced/ Widow(er) (e) Educational Status: High School/ Some College/ College Graduate/ Advanced Degree </p><p>Emergency Contact: ______</p><p>Emergency Contact Phone: ______</p><p>Other People living in your Household</p><p>(a) Name: ______Birth Date: ___/___/____ Relationship to you: ______Primary Service: 7:45am or 11am St Andrew Member: Y or N</p><p>(b)Name: ______Birth Date: ___/___/____ Relationship to you: ______Primary Service: 7:45am or 11am St Andrew Member: Y or N</p><p>(c)Name: ______Birth Date: ___/___/____ Relationship to you: ______Primary Service: 7:45am or 11am St Andrew Member: Y or N</p><p>If you have any comments you would like to express then please leave them on the back of this form (d)Name: ______Birth Date: ___/___/____ Relationship to you: ______Primary Service: 7:45am or 11am St Andrew Member: Y or N</p><p>If you have any comments you would like to express then please leave them on the back of this form</p>