Homes for a Lifetime Video Survey

 

Submit this survey to be eligible to win a $50.00 gift card that can help you start making your home a “home for a lifetime”!

The goal of the Homes for a Lifetime Video Project is to provide information to help older adults live independently through simple, cost-effective home modifications.

The project is a partnership between the Dakota County Communities for a Lifetime Initiative, Access Solutions, Metropolitan Area Agency on Aging, and the City of Burnsville.
1. The video included useful information.
2. I learned new things from the video.
3. The video was easy to understand.
4. The video included practical tips.
5. The video motivated me to make changes in my home.
6. As a result of watching the video I plan to make the following changes in my home:

(Check the modifications you think you will apply to your home.)
7. How did you hear about the Homes for a Lifetime video or receive the DVD?
8. Please share any additional comments. Thanks!
9. Dakota County Communities for a Lifetime Initiative and Access Solutions would like to contact you in 2-3 months to find out if you made changes in your home.

Please list your contact information below if you are willing to be contacted. (This will also enter you to win the gift card.)

Thanks for watching the video and providing feedback. We really appreciate it!
Powered by SurveyMonkey
Check out our sample surveys and create your own now!