Programming Assessment Survey 2010

It’s that time again! Please assist us by participating in our annual survey. We at the West Ouachita Senior Center value your opinion of the facility and programs that you take part in every day. Your honest evaluation, support and suggestions go a long way to help us improve our services to the community.

1. Please tell us the following information?

Please tell us the following information? Name
Phone Number
Address
City, State, Zip
Email Address
Emergency Contact
Contact Number

2. What is your gender?

What is your gender? Male

Female

3. What is your age group?

What is your age group? Under 60

60-69

70-79

80-89

90+

4. What is your race?

What is your race? White/Caucasian

Black/African America

Asian

American Indian/Alaska Native

Native Hawaiian/Other Pacific Islander

Latino/Hispanic

Other (please specify)

5. What is your marital status?

What is your marital status? Married

Widowed

Divorced

Single

6. How often do you attend the senior center?

How often do you attend the senior center? Everyday

1-2 times per week

3-5 times per week

Only Occasional

7. When during the day do you usually attend the West Ouachita Senior Center?

When during the day do you usually attend the West Ouachita Senior Center? In the morning

In the afternoons

All day

8. Do you have a disability?

Do you have a disability? Yes

9. Are you a Veteran?

Are you a Veteran? Yes

10. How do you get to the senior center?

How do you get to the senior center? Drive my own car

Use WOSC transportation services

Friend/relative takes me

Walk

Other

11. How do you find out about activities at the senior center? (check all that apply)

How do you find out about activities at the senior center? (check all that apply) "Rumor'Tis"

"Golden Days", "NewsStar", or "Ouachita Citizen"

WOSC Website

Flyers

Friends/Family

Other (please specify)

12. In which activities do you participate at the senior center?

In which activities do you participate at the senior center? Volunteering

Health screening and nutrition education

Exercise and dance classes, etc.

Music/creative/expressive art classes

Education or computer technology classes

Special events/social activities (parties/luncheons)

Material aid/congregate meal site/loan closet

Other (please specify)

13. Please let us know if you would attend programs or activities at the senior center during the listed times below:

	Yes	No
In the weekday evenings (5-8 PM)	Please let us know if you would attend programs or activities at the senior center during the listed times below: In the weekday evenings (5-8 PM) Yes	In the weekday evenings (5-8 PM) No
On Saturday mornings (AM)	On Saturday mornings (AM) Yes	On Saturday mornings (AM) No
On Saturday evenings (PM)	On Saturday evenings (PM) Yes	On Saturday evenings (PM) No

14. Please list any new programs, support groups, activities, or services you would like to see offered at the senior center.

Please list any new programs, support groups, activities, or services you would like to see offered at the senior center.

15. Please select YES or NO options in reference to the West Ouachita Senior Center.

16. Overall, how satisfied are you with the senior center?

Overall, how satisfied are you with the senior center? Very satisfied

Satisfied

Not satisfied

17. What do you like the best about the senior center?

What do you like the best about the senior center?

18. What do you like least about the senior center?

What do you like least about the senior center?

19. Would you like to become a volunteer at the senior center?

Would you like to become a volunteer at the senior center? Yes

If yes, what number can we reach you at?

20. Do you recieve the bi-monthly newsletter, "Rumor'Tis"?

Do you recieve the bi-monthly newsletter, "Rumor'Tis"? Yes

21. Are you a member of West Ouachita Senior Center?

Are you a member of West Ouachita Senior Center? Yes

	Yes	No	N/A
Overall, the senior center facility is clean and attractive.	Please select YES or NO options in reference to the West Ouachita Senior Center. Overall, the senior center facility is clean and attractive. Yes	Overall, the senior center facility is clean and attractive. No	Overall, the senior center facility is clean and attractive. N/A
Front desk staff is friendly and courteous.	Front desk staff is friendly and courteous. Yes	Front desk staff is friendly and courteous. No	Front desk staff is friendly and courteous. N/A
Front desk staff is knowledgeable and professional.	Front desk staff is knowledgeable and professional. Yes	Front desk staff is knowledgeable and professional. No	Front desk staff is knowledgeable and professional. N/A
Drivers are responsive to my needs.	Drivers are responsive to my needs. Yes	Drivers are responsive to my needs. No	Drivers are responsive to my needs. N/A
I am happy with transportation services.	I am happy with transportation services. Yes	I am happy with transportation services. No	I am happy with transportation services. N/A
I enjoy using congregate meal site.	I enjoy using congregate meal site. Yes	I enjoy using congregate meal site. No	I enjoy using congregate meal site. N/A
I am happy with exercise and fitness classes offered.	I am happy with exercise and fitness classes offered. Yes	I am happy with exercise and fitness classes offered. No	I am happy with exercise and fitness classes offered. N/A
I am happy with the health and wellness presentations and screenings.	I am happy with the health and wellness presentations and screenings. Yes	I am happy with the health and wellness presentations and screenings. No	I am happy with the health and wellness presentations and screenings. N/A
I am happy with the educational and technology classes offered.	I am happy with the educational and technology classes offered. Yes	I am happy with the educational and technology classes offered. No	I am happy with the educational and technology classes offered. N/A
I am happy with recreational and social activities offered.	I am happy with recreational and social activities offered. Yes	I am happy with recreational and social activities offered. No	I am happy with recreational and social activities offered. N/A
I am more physically active.	I am more physically active. Yes	I am more physically active. No	I am more physically active. N/A
I am more mentally active.	I am more mentally active. Yes	I am more mentally active. No	I am more mentally active. N/A
I am better able to live independently in my home.	I am better able to live independently in my home. Yes	I am better able to live independently in my home. No	I am better able to live independently in my home. N/A
I, or a friend, have benefited from material aid and advocacy services.	I, or a friend, have benefited from material aid and advocacy services. Yes	I, or a friend, have benefited from material aid and advocacy services. No	I, or a friend, have benefited from material aid and advocacy services. N/A
I would recommend this center to my friends and family.	I would recommend this center to my friends and family. Yes	I would recommend this center to my friends and family. No	I would recommend this center to my friends and family. N/A

Programming Assessment Survey 2010Exit this survey

1. Please tell us the following information?

2. What is your gender?

3. What is your age group?

4. What is your race?

5. What is your marital status?

6. How often do you attend the senior center?

7. When during the day do you usually attend the West Ouachita Senior Center?

8. Do you have a disability?

9. Are you a Veteran?

10. How do you get to the senior center?

11. How do you find out about activities at the senior center? (check all that apply)

12. In which activities do you participate at the senior center?

13. Please let us know if you would attend programs or activities at the senior center during the listed times below:

14. Please list any new programs, support groups, activities, or services you would like to see offered at the senior center.

15. Please select YES or NO options in reference to the West Ouachita Senior Center.

16. Overall, how satisfied are you with the senior center?

17. What do you like the best about the senior center?

18. What do you like least about the senior center?

19. Would you like to become a volunteer at the senior center?

20. Do you recieve the bi-monthly newsletter, "Rumor'Tis"?

21. Are you a member of West Ouachita Senior Center?

Programming Assessment Survey 2010
Exit this survey