Branch-St. Joseph AAA (IIIC): Older Adult/Caregiver - Community Needs Survey

Thank you for participating in the Branch-St. Joseph Area Agency on Aging (IIIC) community needs assessment. Every three years our agency is required to prepare a Multi-Year Area Plan which documents need and sets priorities for the use of state and federal funding which is used to establish services across Branch and St. Joseph County. Your input will directly affect the development of services in our area.

The survey will collect information about the following: demographics, health, housing, finances, unmet needs and service usage. The survey is anonymous and should only take you about 15 minutes to complete.

If you need assistance to complete the survey, please contact our office: Toll Free at (888) 615-8009 or (517) 278-2538

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* 1. What County do you live in?

Branch

St. Joseph

Other (please specify)

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* 2. How would you describe yourself? (check all that apply)

Caucasian/White

African American/Black

Spanish/Hispanic/Latino

Native American/Alaskan Native

Arab Descent

Native Hawaiian/Pacific Islander

Other/More than one (please specify)

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* 3. Please select the option, or options, that most closely reflect your gender identity

Female

Male

Transgender

Non-Binary/Non-Conforming

Prefer not to respond

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* 4. What is your highest education level?

Less than high school diploma

High school diploma/GED

Some college, including associate degree

Bachelor's degree

Some Post-Graduate work/Advanced degree

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* 5. What is your household income?

At or below $20,000

$20,000 - $35,000

$35,001 - $65,000

$65,001 - $95,000

Over $95,000

Prefer not to answer

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* 6. Do you have a disability?

Yes

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* 7. Have you served in the military?

Yes

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* 8. What is your primary language?

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* 9. What is your age?

Under 55 years

55-59 years

60-64 years

65-69 years

70-74 years

75-79 years

80-84 years

85+ years

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* 10. Do you currently live:

Alone

With a spouse

With relatives, other than a spouse

With non-relatives

With a long-term partner

Other (please specify)