Kalorama Village

Kalorama and Dupont Circle "Villages"

The Kalorama and Dupont Circle communities are actively exploring ways to help our older residents live more independent lives and stay in our neighborhoods. Kalorama Village, Inc., has already been formed as a tax-exempt, non-profit, membership organization and is working with Dupont Circle residents to pursue this initiative. Your response to this brief survey will help us understand the needs of our neighbors. Even if you have no current need for the services that a "Village" might offer, please consider whether you may be interested in the future.

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* 1. Would you (or a family member or friend) be interested in the following types of services in your home?


Referrals to medical professionals	Referrals to medical professionals	Referrals to medical professionals
In-home health caregivers (companions or nursing aides)	In-home health caregivers (companions or nursing aides)	In-home health caregivers (companions or nursing aides)
Home medical equipment	Home medical equipment	Home medical equipment
General advice on healthcare options	General advice on healthcare options	General advice on healthcare options
Financial advice/accounting/tax-preparation services	Financial advice/accounting/tax-preparation services	Financial advice/accounting/tax-preparation services
Handyman/basic home maintenance	Handyman/basic home maintenance	Handyman/basic home maintenance
Plumbing/electrical/HVAC services	Plumbing/electrical/HVAC services	Plumbing/electrical/HVAC services
Household painting	Household painting	Household painting
Cleaning/housekeeper services	Cleaning/housekeeper services	Cleaning/housekeeper services
Computer assistance	Computer assistance	Computer assistance
Meal preparation	Meal preparation	Meal preparation
Assistance with pets	Assistance with pets	Assistance with pets
Personal shopping/concierge services	Personal shopping/concierge services	Personal shopping/concierge services
Transportation	Transportation	Transportation

Other (please specify)

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* 2. How interested would you be if our "Village" sponsored the following kinds of events?


Educational seminars	Educational seminars	Educational seminars
Book clubs/discussion groups	Book clubs/discussion groups	Book clubs/discussion groups
Exercise/healthy living programs	Exercise/healthy living programs	Exercise/healthy living programs
Cultural events (museums, concerts, theater, etc.)	Cultural events (museums, concerts, theater, etc.)	Cultural events (museums, concerts, theater, etc.)
Dinners/social gatherings	Dinners/social gatherings	Dinners/social gatherings

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* 3. Our Village would be open to all residents in the community who are 50 or older. While some services are likely to be of greater interest to older residents, others may be of equal interest to all of our potential members. Younger members may also want to support the initiative to ensure that it is available when they need it in the future. Assuming that we establish a menu of services that provide good value in exchange for a reasonable membership fee, how likely are you to sign up for membership?

Very likely

Somewhat likely

Not likely

Not interested at all

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* 4. How many people aged 50 or older live in your household?

	One	Two	Three	Four or more
Age 50 to 59	Age 50 to 59 One	Age 50 to 59 Two	Age 50 to 59 Three	Age 50 to 59 Four or more
Age 60 to 69	Age 60 to 69 One	Age 60 to 69 Two	Age 60 to 69 Three	Age 60 to 69 Four or more
Age 70 to 79	Age 70 to 79 One	Age 70 to 79 Two	Age 70 to 79 Three	Age 70 to 79 Four or more
Age 80 or older	Age 80 or older One	Age 80 or older Two	Age 80 or older Three	Age 80 or older Four or more

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* 5. Where do you live?

Sheridan-Kalorama

Kalorama Triangle

Dupont Circle

Adams-Morgan

Woodley Park

Cleveland Park

Mt. Pleasant

Georgetown

West End

Other (please specify)

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* 6. I would be interested in using the Village's services for:
(check all that apply)

Myself

My spouse or domestic partner

Another relative or friend

No one at this time

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* 7. Would you be interested in volunteering to help make our Village a strong community resource? (If so, please be sure to provide your contact information below.)

Yes

I would be particularly interested in helping with:

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* 8. If you would like to receive future updates about our Village, please provide us with your contact information. This information will only be used in support of our mission.

Name

Street Address

Apt. or Unit #

City, State

Zip code

Preferred Phone

Email Address

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* 9. How did you hear about Kalorama Village and this survey? (check all that apply)

Kalorama Village website

Letter from Kalorama Village

Other publication/newspaper

Friend/neighbor/relative

AARP

If AARP, please provide your member number below.

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* 1. Would you (or a family member or friend) be interested in the following types of services in your home?

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* 2. How interested would you be if our "Village" sponsored the following kinds of events?

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* 4. How many people aged 50 or older live in your household?

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* 5. Where do you live?

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* 6. I would be interested in using the Village's services for:(check all that apply)

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* 7. Would you be interested in volunteering to help make our Village a strong community resource? (If so, please be sure to provide your contact information below.)

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* 8. If you would like to receive future updates about our Village, please provide us with your contact information. This information will only be used in support of our mission.

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* 9. How did you hear about Kalorama Village and this survey? (check all that apply)

* 6. I would be interested in using the Village's services for:
(check all that apply)