AGCA Chapter Social Media Audit Intake Form
RequiredRequired Question(s)
Required 1.

Please enter the information required and enter your Chapter name in the 'Company' field.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
Address 1:
Address 2:
Postal Code:

Required 2.

Please enter your customer / member / stakeholder audience segments. Use your own words to describe your distinct audiences. (Example: Company owners | regulators | suppliers | etc.) Be as descriptive as possible.


1000 characters left.
Required 3.

Which statement most closely describes your chapter:

We are skeptical of social media and do not use it at all.
We are curious about social media but have not used it yet.
We have tried social media but are not comfortable with it.
We have tried social media but are just now beginning to use it regularly.
We are using social media and consider ourselves as "beginners"
We are using social media more often now and are comfortable with it.
We regularly use social media tools and consider ourselves an "advanced" user.
We consider ourselves as "experts" when it comes to social media.
  • Comment:

  • 500 characters left.
Required 4.

Which social media applications do you currently use and for what main purpose?

 Two-way communication One way communication Monitoring / Listening Only Not used Plan to use 
Google Plus (G+)
RSS News Feeds
We have a "members only" website
Other Online Communities (please list all)
  • Comment:

  • 500 characters left.
Required 5.

For which purposes do you belive your members would use social media?

Mark each that applies

Professional networking
Exchange of information with peers
Marketing or sales
Gathering market intelligence
Personal professional development
News and information
Promotion of their personal "brand"
Promotion of their company / organization
Job seeking
  • Comment:

  • 500 characters left.

How many hours do believe your staff spends on average each week using the following? (Average per individual staff person.)

 0-6 Hours 6-15 hours 16-24 hours 25-40 hours More than 40 
Mobile phone (talk/text/Internet)
Social Media sites (FaceBook, LinkedIn, etc.)
Web Surfing (Websites, Blogs)

Please list the number of contacts / followers / friends you have in your chapter for each of the platforms listed.

 Not Used 0-1,000 1,001-2,500 2.501-5,000 5,001-10,000 More than 10,000 
Email contacts (address book)
Other (please describe)
  • Comment:

  • 500 characters left.
Required 8.

Please indicate how you communicate / deliver information from your Chapter to your members.

 Always Often Occasionally Never  
Mail (hard copy postal service)  
LinkedIn Group  
FaceBook Fan Page / Group  
Google or YahooGroup  
Association Members Only group  
Electronic Newsletter  
SMS Text Message  
Live, Face to Face meetings  
  • Comment:

  • 500 characters left.
Required 9.

Please mark what you feel most correctly describes your chapter in your opinion:

My chapter is a leader in the use of technology
My chapter is at "par" in the use of technology
My chapter is lagging in the use of technology
  • Comment:

  • 500 characters left.
Required 10.

Who in your Chapter, if anyone, is responsible for social media? Please indicate the job title for this person.


350 characters left.
Required 11.

Please describe what you would like social media to do for your Chapter? Please try to include objectives that you expect to be able to measure.


1000 characters left.
Required 12.

Please describe what you feel is the biggest challenge you face regarding the use of social media by your Chapter?


1000 characters left.