We thank you for participating in the Purposeful Aging Survey. 
Your responses and comments are greatly appreciated.

1. What is the name of the City or Town in which your home is located?

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* 1. What is the name of the City or Town in which your home is located?

2. How long have you lived in this City/Town?

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* 2. How long have you lived in this City/Town?

3. What is your 5-digit ZIP code?

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* 3. What is your 5-digit ZIP code?

4. How would you rate your City/Town as a place for people to live as they age?

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* 4. How would you rate your City/Town as a place for people to live as they age?

5. How important is it for you to remain in your City/Town as you age?

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* 5. How important is it for you to remain in your City/Town as you age?

6. As you age, how likely is it that you will move to a different home in your City/Town?

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* 6. As you age, how likely is it that you will move to a different home in your City/Town?

7. As you age, how likely is it that you will move to a different City/Town?

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* 7. As you age, how likely is it that you will move to a different City/Town?

9. What best describes your living arrangement?

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* 9. What best describes your living arrangement?

10. What type of home is your primary home?

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* 10. What type of home is your primary home?

11. How important is it for you to be able to live in your own home as you age?

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* 11. How important is it for you to be able to live in your own home as you age?

14. How do you get around for things like shopping, visiting the doctor, running errands, or going to other places?

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* 14. How do you get around for things like shopping, visiting the doctor, running errands, or going to other places?

16. When compared to most people your age, how would you rate your health?

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* 16. When compared to most people your age, how would you rate your health?

17. How often do you engage in some form of physical exercise (such as walking, running, biking, swimming, sports, strength training, yoga, stretching)?

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* 17. How often do you engage in some form of physical exercise (such as walking, running, biking, swimming, sports, strength training, yoga, stretching)?

19. About how frequently do you have contact with your friends, family, or neighbors? This interaction could be by phone, in person, e-mail, or social media (such as Facebook).

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* 19. About how frequently do you have contact with your friends, family, or neighbors? This interaction could be by phone, in person, e-mail, or social media (such as Facebook).

20. Is the contact described above…

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* 20. Is the contact described above…

21. Do you participate in continuing education or self-improvement classes/workshops? (CHECK ALL THAT APPLY)

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* 21. Do you participate in continuing education or self-improvement classes/workshops? (CHECK ALL THAT APPLY)

23. Which of the following best describes your current employment status?

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* 23. Which of the following best describes your current employment status?

24. If employed, how likely is it that you will retire?

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* 24. If employed, how likely is it that you will retire?

26. Would you turn to the following resources if you, a family member or friend needed information about services for older adults, such as caregiving services, home-delivered meals, home repair, medical transport or social activities? (CHECK ALL THAT APPLY)

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* 26. Would you turn to the following resources if you, a family member or friend needed information about services for older adults, such as caregiving services, home-delivered meals, home repair, medical transport or social activities? (CHECK ALL THAT APPLY)

34b. If “YES” to either question above, please tell us what kind of help you feel might be useful? If “NO”, please go to the next question.  (CHECK ALL THAT APPLY):

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* 34b. If “YES” to either question above, please tell us what kind of help you feel might be useful? If “NO”, please go to the next question.  (CHECK ALL THAT APPLY):

ABOUT YOU…
D1. Are you male or female?

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* D1. Are you male or female?

D2. Do you think of yourself as…(CHECK ALL THAT APPLY)

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* D2. Do you think of yourself as…(CHECK ALL THAT APPLY)

D3. What year were you born?

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* D3. What year were you born?

D4. What is your current marital status?

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* D4. What is your current marital status?

D5 a. If "NO", how many people regularly live in your household? If “YES”, please go to the next question.

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* D5 a. If "NO", how many people regularly live in your household? If “YES”, please go to the next question.

D5 b. If “NO” to D5, are you currently living with… (CHECK ALL THAT APPLY)

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* D5 b. If “NO” to D5, are you currently living with… (CHECK ALL THAT APPLY)

D5 c. If “NO” to D5, are you a family caregiver?

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* D5 c. If “NO” to D5, are you a family caregiver?

D5 d. If “YES” to D5 c, are you a caregiver for… (CHECK ALL THAT APPLY)

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* D5 d. If “YES” to D5 c, are you a caregiver for… (CHECK ALL THAT APPLY)

D7. Does any disability, handicap, or chronic disease keep you and/or your spouse or partner from fully participating in work, school, housework or other activities? (CHECK ONLY ONE)

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* D7. Does any disability, handicap, or chronic disease keep you and/or your spouse or partner from fully participating in work, school, housework or other activities? (CHECK ONLY ONE)

D9. Which language do you prefer to speak at home? (CHECK ONLY ONE)

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* D9. Which language do you prefer to speak at home? (CHECK ONLY ONE)

D10. What is your race and/or ethnicity? (CHECK ALL THAT APPLY)

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* D10. What is your race and/or ethnicity? (CHECK ALL THAT APPLY)

D11. What is the highest level of education you have completed?

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* D11. What is the highest level of education you have completed?

D13. In general, how often do you go online to access the Internet for things like sending or receiving e-mail, getting news and information, paying bills or managing finances, or buying products or services? This includes access from home, work, a mobile device (such as a smartphone), or someplace else.

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* D13. In general, how often do you go online to access the Internet for things like sending or receiving e-mail, getting news and information, paying bills or managing finances, or buying products or services? This includes access from home, work, a mobile device (such as a smartphone), or someplace else.

D14. What was your annual household income before taxes in the most recent tax year?

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* D14. What was your annual household income before taxes in the most recent tax year?

Please use the space below for any additional comments

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* Please use the space below for any additional comments

Thank you very much for completing this survey.
Your assistance in providing this information is greatly appreciated.

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