LGBTQ 50+ Alliance LGBTQ 50+ Alliance Survey Prepared by OutReach Community Center and the Madison Senior Center OK Question Title * 1. Would you like to participate in activities designed for LGBTQ individuals age 50 and older? Yes No Maybe (Please elaborate) OK Question Title * 2. What is your age? OK Question Title * 3. Have you participated in LGBTQ 50+ Alliance activities previously? Yes No OK Question Title * 4. Who is your interest in activities primarily with? Females Males Mixed Transgender Non-Binary Queer Other OK Question Title * 5. Would you be interested in facilitating a program or activity? Yes No Maybe (Please Explain) OK Question Title * 6. What activity or program are you interested in facilitating? OK Question Title * 7. Do you have a device (computer, laptop, smart phone, etc) to participate in virtual programs during the COVID-19 restrictions? Yes No OK Question Title * 8. Are there any barriers or obstacles that prevent you from participating in activities? Transportation Schedule Disability Cost Location Internet Access None Other (please specify) OK Question Title * 9. What are your preferred days of the week for program participation? Monday Tuesday Wednesday Thursday Friday Saturday Sunday OK Question Title * 10. What time of day do you prefer to participate in programs? Morning Afternoon Evening It Depends (please explain) OK Question Title * 11. Below is a list of current activities. Please check all activities that you might be interested in. Book Club Game Night Coffee Meet-Ups Discussion Groups Billiards Kayaking or Canoeing Quarterly Social Dinners Other (please specify) OK Question Title * 12. Please share your information below if you would like someone from the LGBTQ 50+ Alliance to contact you. Name ZIP/Postal Code Email Address Phone Number OK Question Title * 13. Additional Comments OK DONE
