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Step
1
of 12
Select Ethnicity
Select Ethnicity
African
African Born
African Descendants
Non-African Born (Ex. Mixed with African or African Descendant)
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Nationality Detail
Name:
*
Gender:
*
Male
Female
Age:
*
Date of Birth:
*
City:
*
(City you were born)
State:
*
(State you were born)
Country:
*
(Country you were born)
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Personal Detail
Email:
*
Current Address:
*
Apartment No.:
*
(If you live in an apartment)
City:
*
State:
*
Country:
*
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Household Detail
Are you married or single:
Married
Single
Do you own or rent?
Own
Rent
How many bedroom:
How many bathroom:
How many car(s) can fit in your garage:
Do you currently pay a monthly mortgage:
Yes
No
Monthly Rent:
How many bedroom:
How many bathroom:
Do you park indoor or outdoor:
Do you pay extra for parking:
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Health Insurance Detail
Do you currently have health insurance?
Yes
No
Do you have Medical Assistance through your State?
Yes
No
Do you have Private Insurance?
Yes
No
How much do you pay monthly for Private Insurance?
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Dependents
Are you the head of household?
Yes
No
How many dependent(s) live with you?
How many dependent(s) are children?
How many dependent(s) are adult?
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you in your
Questionnaire-1
Do you believe we should have your Country embassy currently within the State you reside in?
Yes
No
Do you like traveling to another state within the U.S. to renew your passport/other documents?
Yes
No
Do you believe we should have a secured universal website that provides passport/citizenship information for the African Continent?
Yes
No
Do you believe there should be a universal fee for filing or renewal your passport/documents in Africa?
Yes
No
Have you ever been scammed during any passport related process?
Yes
No
If this questionnaire does not apply to you, please click “CONTINUE.”
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Questionnaire-2
Do you still have family relatives living in Africa?
Yes
No
If you have family relatives still living in Africa, do you help pay medical bills?
Yes
No
If you have family relatives still living in Africa, do you help pay for educational expenses?
Yes
No
If you have family relatives still living in Africa, do you help pay for miscellaneous expenses such as for food, clothing, light and supplies?
Yes
No
Do you have any health insurance when you are back in Africa?
Yes
No
If this questionnaire does not apply to you, please click “CONTINUE.”
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Questionnaire-3
What is your average annual income?
$15,000-$25,000
$26,000-$35,000
$36,000-$45,000
$46,000-$55,000
$56,000-$65,000
$66,000-$75,000
$76,000 +
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Questionnaire-4
Would you like to buy a home?
Yes
No
Has your credit score been an issue with moving forward?
Yes
No
Has the closing cost been an issue with moving forward?
Yes
No
Has your annual income been an issue with moving forward?
Yes
No
Do you believe the monthly mortgage is a decisive factor stopping you from moving forward?
Yes
No
If this questionnaire does not apply to you, please click “CONTINUE.”
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Questionnaire-5
Do you have children?
Yes
No
Would you allow your child to go to a boarding school?
Yes
No
Would you allow your child to go to a charter school?
Yes
No
Would you allow your child to learn a second or third language?
Yes
No
If your child was accepted and it’s affordable, would you allow your child to attend?
Yes
No
If this questionnaire does not apply to you, please click “CONTINUE.”
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Questionnaire-6
Do you have a Life Insurance Policy?
Yes
No
Do you know how life insurance policy works?
Yes
No
Do you have a Trust in place?
Yes
No
Are you considering establishing a trust?
Yes
No
Do you have a Traditional IRA or ROTH IRA?
Yes
No
If this questionnaire does not apply to you, please click “CONTINUE.”
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