DEMOGRAPHIC INFORMATION

Tell us a little about yourself!

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* 1. What is your age?

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* 2. Gender?

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* 3. Household Composition? Check all that apply.

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* 4. How do you currently get information about programs and services? Check all that apply.

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* 5. How do you prefer to get information ?

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* 6. Please select any Arts and Humanities Programs that interest you:

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* 7. Please select any Community Events that interest you:

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* 8. Please select any Education/Science/Nature/Technology Programs that interest you:

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* 9. Please select any Fitness Programs that interest you:

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* 10. Please Select any Health / Nutrition Programs that interest you:

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* 11. Please Select any Legal, Financial, and Benefit Programs that interest you:

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* 12. Please select any Music / Dancing Programs that interest you:

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* 13. Please select any Social / Supportive / Recreational Programs that interest you:

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* 14. Please select any Social Services Programs that interest you:

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* 15. Please select any Trips to Destinations that interest you:

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* 16. Please List barriers to participation that your household has experienced:

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* 17. Any additional comments or feedback?

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* 18. If you would like the COA or PRD to follow up with you directly, please leave your name and the best way to reach you.  

0 of 18 answered
 

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