2020-2023 Area Plan Survey

Thank you for your participation in the survey.  The survey will help the agency identify needs and address programming that supports older adults, adults with disabilities and their caregivers.  Your responses are anonymous and will not be utilized for any other purpose than stated above.

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* 1. WHAT COUNTY DO YOU LIVE IN?

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* 2. WHAT IS YOUR GENDER?

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* 3. WHAT IS YOUR AGE?

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* 4. I...

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* 5. ARE YOU A VETERAN?

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* 6. WHAT UNMET NEEDS EXIST FOR YOU OR YOUR FAMILY? (Select all that apply)

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* 7. HOW DO YOU GET WHERE YOU NEED TO GO?

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* 8. DO YOU PROVIDE UNPAID ASSISTANCE OR CARE FOR A FAMILY MEMBER, FRIEND OR NEIGHBOR?

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* 9. IF YES, HOW MANY ESTIMATED HOURS OF CARE PER WEEK DO YOU PROVIDE?

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* 10. HOW OLD IS THE PERSON YOU CARE FOR?

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* 11. IF YOU ARE CARING FOR SOMEONE, DO YOU NEED HELP WITH ANY OF THE FOLLOWING? (Select all that apply)

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* 12. WHAT KIND OF CAREGIVER TRAINING WOULD BE MOST HELPFUL TO YOU? (select all that apply)

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* 13. FOR WHAT PURPOSES DO YOU NEED TRANSPORTATION? (select all that apply)

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* 14. WHAT ARE YOUR BARRIERS TO TRANSPORTATION?

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* 15. HOW DO YOU GET YOUR INFORMATION ABOUT AGING PROGRAMS AND/OR SERVICES?

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* 16. What type of health and wellness programs do you participate in? (check all that apply)

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* 17. WHICH WELLNESS PROGRAMS DO YOU THINK ARE NEEDED IN YOUR COUNTY?

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