CPRS DISTRICT 5 AGING ROUND TABLE SURVEY

District 5 Membership

We are excited to announce the CPRS District 5 Board has a new Aging Representative: Shannon Parker from Modesto would like to start Aging Round Table sessions and needs your input. Please complete the questions below:

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* 1. Does your City/organization have a senior center or community center with senior programs?

YES

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* 2. Does your City/organization have a Senior Supervisor/Coordinator?

Yes

Not at this time, however we are hoping to hire someone soon.

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* 3. What is the name and contact information for your Senior Supervisor and/or Coordinator?

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* 4. Please choose what time and day is best for you to attend Aging Round Tables:

TUESDAY MORNING (BETWEEN 8AM-12PM)

TUESDAY AFTERNOONS (BETWEEN 12PM-4PM)

TUESDAYS ARE NOT GOOD FOR ME ANY TIME

List other days available:

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* 5. Please list topics you would be interested in discussing at these Round Tables. (Facilities, games, challenges, etc.)

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* 6. Would you be willing to host an Aging Roundtable at your City/organization?

YES

MAYBE (NEED MORE INFORMATION)

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* 7. We appreciate you taking time to complete our survey. Please leave us your information so that we are able to forward upcoming information to you:

Name

City/Town

Email Address

Phone Number