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* 1. The following information allows the HVCA to better understand and compare your answers to others in the community.
Please indicate your age:

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* 2. What is your gender?

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* 3. Do you own or rent your home?

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* 4. What do you feel are the most important issues facing seniors in our community?

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* 5. Please tell us about the community activities you participate in.
What is your preference for "formal" leisure activities? (Please select only one option below).

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* 6. What activities have you done in the past year? (Check all that apply below):

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* 7. What learning opportunities have you attended this year? (check all that apply):

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* 8. If learning opportunities were available in your direct community, what would you like to learn more about? (check all that apply)

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* 9. The following questions, ask about health, lifestyle and health care.
Which of the following best describes your work and retirement plan? (Select the one that most applies to you)

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* 10. Is there a person or people in your life...(check all that apply):

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