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Community Well
Consent
*
1.
The Community Well is a community wellness center created by the Presbyterian Church of Lawrenceville (PCOL), which offers services that promote wellness of body, mind, and spirit.
To help ensure our services offered are in line with the needs of the community we are seeking your thoughts in this survey. We would greatly appreciate five minutes of your time to answer a few questions.
Your responses will be confidential. The surveys will not contain information that will personally identify you, such your name, email or IP addresses.
Clicking on the "agree" button below indicates that:
• you have read the above information
• you voluntarily agree to participate
• you are at least 18 years of age
If you do not wish to participate in this survey, please decline participation by clicking on the "disagree" button.
(Required.)
Agree
Disagree
2.
Please tell us about yourself
Name
Email Address
3.
Do we have your permission to subscribe you to our e-Newsletter (easy to unsubscribe)?
Yes
No
4.
How do you feel about community in general? To what extent do you agree or disagree with the following statements?
Agree Strongly
Agree Somewhat
Disagree
I feel a great sense of community around me through my activities and involvements
Agree Strongly
Agree Somewhat
Disagree
I have a great desire for more community with others and with groups
Agree Strongly
Agree Somewhat
Disagree
I feel fairly disconnected from a sense of community for myself
Agree Strongly
Agree Somewhat
Disagree
5.
What is your perception of the Lawrenceville area community? How would you describe it ? (Choose as many as you wish)
There are lots of opportunities to serve and get connected within the community
It's an unfriendly place
Lawrenceville seems somewhat disconnected and has little sense of community
Lawrenceville really has a great sense of community
There is a genuine care for neighbors in this community
how else would you describe it? (please specify)
6.
What local activities do you participate in? Please select all that apply to you.
Fitness class
Musical group/choir/music class
Hobby or interest group
Cooking classes
Church group
Therapeutic group (group counseling, AA, NA, etc.)
Individual Counseling (therapy)
Theatre or performing arts
Book or discussion group
Community service
Dance class
Support or Affinity group
Other (please specify)
7.
Which facilities or services would you most like to see in the Lawrenceville village community? Please check as many as you wish.
Cooking classes and healthy eating support
Affinity or support groups
Adult learning classes and lectures ( e.g.financial literacy)
An indoor space to exhibit public artworks
Running, hiking, biking groups
A performance space for plays and concerts
A place for fitness classes
More space for recovery groups (AA/NA, etc.)
A large gathering space for community meetings and events
An indoor space for sports, e.g. basketball, volley ball
Community service opportunities
Other suggestions (please specify)
8.
What is your general impression of the Presbyterian Church of Lawrenceville (PCOL)?
I have a very favorable opinion of it
I have a moderately favorable opinion of it
I have a negative opinion of it
None/No opinion
9.
Please tell us briefly why PCOL gave you a positive or negative impression, (or skip to next question if you have no opinion of it)?
10.
Which of the following local groups or organizations do you have an association with? Please select as many as apply to you.
Presbyterian Church of Lawrenceville (PCOL)
Temple Micah
Every Child Valued
Lawrence Presbyterian Church
Lawrenceville Main Street
Arm in Arm
Science Mentors
The Lawrenceville Presbyterian Preschool
WorkWell
The Joshua Prayer Group
YMCA Programming happening at PCOL
A Program affiliated with the Community Well
The Central Presbytery of New Jersey
Scouting
Other (please specify)
11.
What is your gender?
Female
Male
Non-binary / third gender
Prefer not to say
12.
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
13.
Which of the following best describes your current relationship status?
Married
Widowed
Divorced
Separated
In a domestic partnership or civil union
Single, but cohabiting with a significant other
Single, never married
Other
14.
How many children under 18 yrs do you have living with you?
None
1 child
2 children
3 children
More than 3 children
15.
How many preschool children do you have living with you?
None
1 child
2 children
3 children
More than 3 children
16.
If you have a child or children, in what activities do they participate?
Please select all that apply.
School affiliated sports
Non-school affiliated sports
After-school program
STEM Enrichment activity
Music lessons
Art activity/lessons
Theatre program
Dance
Homework help/college prep classes
17.
If you have a child or children, in what activities might they participate if they were offered at the Community Well?
School affiliated sports
Non-school affiliated sports
After-school program
STEM Enrichment activity
Music lessons
Art activity/lessons
Theatre program
Dance
Homework help/college prep classes
Other (please specify)
18.
In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)
19.
What is your race or ethnicity?
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Multiracial or Multiethnic
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
Self-describe below:
20.
Which town do you live in
East Windsor
Ewing
Hopewell
Lawrenceville
Pennington
Princeton
Trenton
West Windsor
Other (please specify)
21.
What is your approximate average household income?
$0-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$174,999
$175,000-$199,999
$200,000 and up
Don't Know/Don't wish to answer
22.
Anything else you'd like to share with us?
Current Progress,
0 of 22 answered
