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?

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

* 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?

* 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?

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

* 9. What best describes your living arrangement?

* 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?

* 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?

* 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).

* 20. Is the contact described above…

* 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?

* 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)

* 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?

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

* D3. What year were you born?

* 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.

* 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?

* 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)

* 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)

* 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.

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

* 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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