Consent

Question Title

* 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.

Question Title

* 2. 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 have a great desire for more community with others and with groups
I feel a great sense of community around me through my activities and involvements
I feel fairly disconnected from a sense of community for myself

Question Title

* 3. What is your perception of the Lawrenceville area community? How would you describe it ? (Choose as many as you wish)

Question Title

* 4. What local activities do you participate in? Please select all that apply to you.

Question Title

* 5. Which facilities or services would you most like to see in the Lawrenceville village community? Please check as many as you wish.

Question Title

* 6. What is your general impression of the Presbyterian Church of Lawrenceville (PCOL)?

Question Title

* 7. 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)?

Question Title

* 8. Which of the following local groups or organizations do you have an association with? Please select as many as apply to you.

Question Title

* 9. What is your gender?

Question Title

* 10. What is your age?

Question Title

* 11. Which of the following best describes your current relationship status?

Question Title

* 12. How many children under 18 yrs do you have living with you?

Question Title

* 13. How many preschool children do you have living with you?

Question Title

* 14. If you have a child or children, in what activities do they participate?
Please select all that apply.

Question Title

* 15. If you have a child or children, in what activities might they participate if they were offered at the Community Well?

Question Title

* 16. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

Question Title

* 17. What is your race or ethnicity?

Question Title

* 18. Which town do you live in

Question Title

* 19. What is your approximate average household income?

0 of 19 answered
 

T