Muskingum County Center for Seniors Question Title * 1. Have you ever been to the Muskingum County Center for Seniors? Yes No Question Title * 2. If you have been to the Center for Seniors what brought you in? lunch AM activities PM activities Inquiring about assistance A special event I volunteer at the Center. I attended a community meeting at the Center but do not come for activities. Other (please specify) Question Title * 3. How often do you come to the Center? Every day A few times a week About once a week A few times a month Once a month Less than once a month I have never been to the Center for Seniors. Other (please specify) Question Title * 4. If you have never been to the Center for Seniors, Why? Question Title * 5. If you have never been to the Center for Seniors or you visit less than regularly, what events or activities would interest you? Question Title * 6. We would like to keep you informed of the Center for Seniors! If you would like us to send you more information please fill out the following Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Done