Region IV Area Agency on Aging Older Adults Community Survey

Who should complete this survey?

If you are 60 or over and a resident of Berrien, Cass or Van Buren counties, we want to hear from you! This survey asks about the needs of seniors who live in these counties. Your answers will help the Area Agency on Aging (AAA) plan and develop services to meet the needs of our community's older adults and their caregivers.

Please complete a survey if: You are age 60 or older OR You are a caregiver for someone 60 or older who is unable to complete the survey.

For more information or for help completing this survey, please call the Area Agency on Aging at (800) 442-2803.

Question Title

* 1. Age

Under 60

60-64

65-69

70-74

75-79

80-84

85+

Question Title

* 2. Gender

Male

Female

Question Title

* 3. Race/Ethnicity

American Indian/Alaskan Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

White/Caucasian

Spanish/Hispanic

Question Title

* 4. What is the size of your household?

1-person

2-person

3-person

4-person

Question Title

* 5. Is your income level, for your household size, below poverty? (see 2015 poverty guidelines below)

1-person at or below $11,770 per year OR at or below $980 per month
2-person at or below $15,930 per year OR at or below $1,372 per month
3-person at or below $20,090 per year OR at or below $1,674 per month
4-person at or below $24,250 per year OR at or below $2,020 per month

Yes

Question Title

* 6. Zip Code (input)

Question Title

* 7. Do you live alone?

Yes

Question Title

* 8. Do you consider yourself a caregiver? (a person who provides care to an aging spouse, parent or other person)?

Yes