Every three years, the Aging and Disability Resource Center of Door County is required by the State of Wisconsin to complete a strategic plan that serves as a platform to create, improve and expand services we provide our community. It is required to receive federal funding through the Older Americans Act. The working document is known as our “Three Year Aging Plan” and will cover years 2019-2021. Our staff and advisory committee members all participate in the development of this plan, but most important is input from you. Please fill this questionnaire out and return it to us.

What part of Door County do you live?

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* 1. What part of Door County do you live?

What is your gender?

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* 2. What is your gender?

How old are you?

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* 3. How old are you?

Where do you receive or look for information on the news around Door County? (Check all that apply)

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* 4. Where do you receive or look for information on the news around Door County? (Check all that apply)

Are you aware of the Aging and Disability Resource Center of Door County?

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* 5. Are you aware of the Aging and Disability Resource Center of Door County?

What do you feel are the main challenges in your life? (Check all that apply)

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* 6. What do you feel are the main challenges in your life? (Check all that apply)

Are you providing assistance or support for a family member or friend?

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* 7. Are you providing assistance or support for a family member or friend?

Are you receiving assistance or support for a family member or friend?

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* 8. Are you receiving assistance or support for a family member or friend?

Do you know someone who is living with dementia or Alzheimer’s?

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* 9. Do you know someone who is living with dementia or Alzheimer’s?

Do you currently live alone?

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* 10. Do you currently live alone?

In an effort to improve the services provided to the older adult population of Door County, we would be interested in knowing if there are any issues that you are aware of that aren’t being met?

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* 11. In an effort to improve the services provided to the older adult population of Door County, we would be interested in knowing if there are any issues that you are aware of that aren’t being met?

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