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1. Which senior center do you attend?

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2. Age

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3. Gender

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4. Race

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5. Household Composition. Do you live...

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6. How did you learn about the center?

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7. How long have you been receiving services provided by the senior center?

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8. On average, how many days per week do you attend activities at the senior center?

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9. If you are receiving services remotely (printed materials, crafts, etc.), do you feel they help you stay informed and connected to the center?

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10. Do you participate in senior center activities via virtual or teleconferencing platforms?

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11. Do you find our staff courteous and professional?

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12. Are you aware that you can make a donation toward our program if you wish?

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13. What other activities would you be interested in that are not currently offered at your senior center?

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14. Overall, how satisfied are you with the programs and services offered by the senior center?

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15. Do you eat meals provided by the center? If you check No skip question 16.

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16. Are you satisfied with the....

  Always Sometimes Never
Food Taste
Food Smell
Food Appearance
Food Variety
Food Temperature
Food Service Time

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17. How useful was this month’s nutrition education in helping you make healthy food and nutrition choices?

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18. Do you feel that the nutrition education provided through this program has helped lower your risk of nutrition-related health problems?

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19. Write your comments on the meal service here:

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