Senior Pride SurveySenior Pride Survey

SAGE Metro-DC and The Washington, DC LGBT Aging Coalition

Please help us do better planning to assist LGBT seniors in the District of Columbia by filling out this short, 20 question survey.

If you are a resident of the Distict and over 60 years of age...we are looking for you to help by filling out this survey as soon as you can.

By the way this is just a test...the final version will have no email connections so it will be totally anonymous. If there are questions on this version that you feel are to personal please skip them. Thanks

1. What City Ward do you live in?

What City Ward do you live in? 1

2. If you don’t know, what is your zip code?

If you don’t know, what is your zip code?

3. What is your date of birth? 19____?

What is your date of birth? 19____?

4. What racial group are you a member?

What racial group are you a member? White

Hispanic

Asian

Other?

5. How do you describe your sex?

How do you describe your sex? Male

Female

Trans

6. How do describe your sexual orientation?

How do describe your sexual orientation? Gay

Lesbian

Bi-Sexual

Heterosexual

Homosexual

Queer

Other

7. How OUT would you say you are? On a scale from 1 to 10?
(1, out to very select group of people in my life……to……… 10 out to family, work, & public)


1-10	*How OUT would you say you are? On a scale from 1 to 10? (1, out to very select group of people in my life……to……… 10 out to family, work, & public) 1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10

8. Did you ever serve in the Armed Forces?

Did you ever serve in the Armed Forces? Yes

9. Are you/have you ever been married to a member of the opposite sex?

Are you/have you ever been married to a member of the opposite sex? Yes

10. Do you have any children?

Do you have any children? Yes

11. Do you currently have a partner/husband/wife of the same sex?

Do you currently have a partner/husband/wife of the same sex? Yes

12. My HIV status is:

My HIV status is: Positive

Negative

Don't know

13. Are you aware of age discrimination in the LGBT community?

Are you aware of age discrimination in the LGBT community? Yes

14. How much of a problem is age discrimination in the LGBT Community? (1, not much of a problem…10, serious problem)


1-10	*How much of a problem is age discrimination in the LGBT Community? (1, not much of a problem…10, serious problem) 1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10	1-10

15. Have you ever experienced this type of discrimination?

Have you ever experienced this type of discrimination? Yes

16. If you were to need social services in the District, would you feel comfortable letting agency staff know you are a member of the GLBT community?

If you were to need social services in the District, would you feel comfortable letting agency staff know you are a member of the GLBT community? Yes

Depends

17. Are you currently receiving any social services in the District?

Are you currently receiving any social services in the District? Yes

18. What kind of health insurance do you now use?

What kind of health insurance do you now use? Private

Medicare

Medicaid

19. Are you aware of programs/organizations already in place in our community for GLBT elders?

Are you aware of programs/organizations already in place in our community for GLBT elders? Yes

20. Can you name one or two of those organizations?

Can you name one or two of those organizations?

21. What would you say is the greatest need of GLBT seniors in the District?

What would you say is the greatest need of GLBT seniors in the District?

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SAGE Metro-DC and The Washington, DC LGBT Aging Coalition

Senior Pride Survey
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