2009 Bolton Senior Center Survey

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1. What is your age?

What is your age? 60-69

70-79

80 and above

Please provide your name, email address, and telephone number to enter into the raffle drawing: (optional)

2. What is your gender?

What is your gender? Female

Male

3. Do you require transportation to the senior center?

Do you require transportation to the senior center? Yes

Occasionally

4. Do you already participate in programs at the Bolton Senior Center?

Do you already participate in programs at the Bolton Senior Center? Yes

5. When do you prefer to participate in social activities? (select all that apply)

When do you prefer to participate in social activities? (select all that apply) Morning

Afternoon

Evening

6. I would participate in the following services regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply)

I would participate in the following services regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply) Legal assistance (wills, power of attorney, medical powers of attorney, etc.)

Assistance with tax preparation

Telephone reassurance (daily check in calls)

Congregate meals at the senior center

Home delivered meals

Information/referral services

Health and prescription assistance

Health and nutrition classes

Other (please specify)

7. I would participate in the following activities regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply):

I would participate in the following activities regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply): Yoga classes Fitness classes Tai Chi classes Exercise equipment classes Wii Walking classes Supervised walking Trail walking Bridge games Poker games Dominoes	Scrabble Bingo Educational Lectures Travel Programs Current Events talks Sewing, quilting, crafting classes Woodworking classes Ceramics classes Dances or dance lessons Billiards, shuffleboard, ping pong Book Club	Journal writing, story telling, creative writing Art classes Photography classes Music classes Music appreciation Music recitals Afternoon Movies Evening Movies Garden Club Social gatherings, theme parties, holiday parties
Other (please specify)

8. I would be interested in participating in the following types of trips regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply):

I would be interested in participating in the following types of trips regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply): Day trips to museums, libraries

Day trips to special cultural (movies, plays, operas, ballets) or sporting events

Shopping trips

Lunch outings

Dinner outings

Monthly breakfasts

Other (please specify)

9. Do you find the existing Bolton Senior Center facility adequate?

Do you find the existing Bolton Senior Center facility adequate? Yes

If "NO", would you prefer: (select all that apply)

A large community center where all ages meet

A large community center with an attached senior wing

A new, dedicated senior center with more activities, space, and meeting rooms

If "No", why?

10. What are the problems and barriers to accessing services and programs, if any?

What are the problems and barriers to accessing services and programs, if any? Transportation difficulties

Lack of adequate facilities

Don't know about services

Don't know how to access/enroll in services

Too busy

Just don't want to go

Other (please specify)

1. Default Section

1. What is your age?

2. What is your gender?

3. Do you require transportation to the senior center?

4. Do you already participate in programs at the Bolton Senior Center?

5. When do you prefer to participate in social activities? (select all that apply)

6. I would participate in the following services regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply)

7. I would participate in the following activities regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply):

8. I would be interested in participating in the following types of trips regularly, if they were available free of charge or for a significantly reduced rate. (select all that apply):

9. Do you find the existing Bolton Senior Center facility adequate?

10. What are the problems and barriers to accessing services and programs, if any?