FEDERATION OF CYPRIOT AMERICAN ORGANIZATIONS
333 Glen Head Rd, Suite 250, Glen Head, New York 11545
http://www.fcaousa.org
Last Name:
First Name:
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Address:
City:
State:
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Zip:
-
Zip Suffix
Home Phone:
Mobile Phone:
Email:
Gender:
Female
Male
Other
Birth Date (MM/DD/YYYY):
/
/
Marital Status:
Married
Single
Spouse's Last Name:
Spouse's First Name:
Highest degree or level of schooling (optional):
Less than High School
High School Graduate
Some College
Associates Degree
Bachelor's Degree
Master's Degree
Doctorate Degree
Current Employment Status:
Employed
Unemployed
Retired
Homemaker
Self Employed
Student
Occupation/Profession:
Administrative
Arts and Entertainment
Broadcasting
Computer, Software and Information Services
Construction
College, University and Adult Education
Doctor
Finance
Government and Public Administration
Health Care and Social Assistance
Hotel and Food Services
Lawyer
Military
Publishing
Primary/Secondary (K-12) Education
Real Estate
Retail
Wholesale
Other
N/A
If Other, please specify:
Role in the industry:
Upper Management (CEO, President, Owner, CFO)
Middle Management
Junior Management
Administrative Staff
Support Staff
N/A
Approximate household annual income (optional):
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $249,999
Over $250,000
Ethnic Group:
Greek Cypriot
Armenian Cypriot
Maronite Cypriot
Latin
Turkish Cypriot
Other
If Other, please specify:
Country of Birth:
Cyprus
Greece
United States
Other
If Other, please specify:
District (if Cyprus):
Nicosia
Limassol
Larnaca
Paphos
Famagusta
Kyrenia
Other
Municipality (if Cyprus):
Village (if Cyprus):
What generation of Cypriot American are you?
1st Generation
2nd Generation
3rd Generation
Other or N/A
If Other, please specify:
Birthplace of father:
Nicosia
Limassol
Larnaca
Paphos
Famagusta
Kyrenia
Other
If Other, please specity:
Village (if Cyprus):
Birthplace of mother:
Nicosia
Limassol
Larnaca
Paphos
Famagusta
Kyrenia
Other
If Other, please specify:
Village (Cyprus):
I am the spouse of a:
First generation Cypriot American
Second generation Cypriot American
Third generation Cypriot American
Other
If Other, please specify:
Proficiency level of the Greek language: Speaking
Excellent
Good
Average
Poor
None
Proficiency level of the Greek language: Reading/Writing
Excellent
Good
Average
Poor
None
ORGANIZATION AND CHURCH AFFILIATIONS
Are you affiliated with any Greek or Cypriot Associations or Groups?
Yes
No
Name of Association/Group:
Name of Association/Group:
Name of Association/Group:
Are you a member of a Greek Orthodox Church?
Yes
No
Name of Church
City
State
Are you affiliated with any social media accounts?
Yes
No
If YES check all that apply:
Other:
Would you like to receive information on FCAO upcoming events and newsletters?
Yes
No
Last Name:
First Name:
Date of Birth:
Gender:
Male
Female
Other
Last Name:
First Name:
Gender:
Male
Female
Last Name:
First Name:
Gender:
Male
Female
Last Name:
First Name:
Gender:
Male
Female
Last Name:
First Name:
Gender:
Male
Female
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