Stanislaus County Older Adult Survey Question Title * 1. Is planning for retirement an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 2. Is the cost of energy/utilities an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 3. Is getting information about services/benefits an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 4. Is housing an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 5. Is remaining in your home an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 6. Is loneliness an issue, condition or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 7. Do you feel sad frequently? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 8. Is needing legal assistance an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 9. Is meeting expenses an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 10. Is transportation an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 11. Are accidents/falls an issue, condition or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 12. Is physical, emotional and/or financial abuse an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 13. Is relief from caregiving responsibilities an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 14. Is accessing services for caregiving an issue or concern for you? Not a Problem Minor Problem Serious Problem Very Serious Problem Question Title * 15. What other issues or concerns do you have? Please state. Question Title * 16. Which category below includes your age? under 55 55-59 60-64 65-74 75-84 85+ Question Title * 17. Please indicate your 2011 monthly income: If married: $0-$1,2226 $1,227-$1,532 $1,533 and above Question Title * 18. Please indicate your 2011 monthly income: If single: $0-$907 $908-$1,134 $1,135 and above Question Title * 19. What is your primary language? English Spanish Other Other (please specify) Question Title * 20. Do you drive your own vehicle? Yes No Question Title * 21. If you do not drive, what form of transportation do you use most often? Ride with family/friends City Bus Dial-a-Ride Volunteer Service Question Title * 22. Is public transportation accessible where you live? Yes No Question Title * 23. If you would like information about senior services in Stanislaus County, please supply your name and contact information. Submit response >>