Community Needs Assessment Survey To better understand the needs, challenges, and preferences of adults 50+ in our community so that programs, services, and resources can be aligned to support quality of life.

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* 1. Basic Information (Optional and Confidential)

Age

Gender (male or female)

Living situation (alone, spouse/partner, family, assisted living, other)

Zip Code

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* 2. Are you satisfied with your current housing?

Yes

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* 3. Do you have concerns about housing and living affordability? Mark all that apply.

Afforability

Safety

Accessibility (stairs, bathroom, etc.)

Other (please specify)

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* 4. Do you have reliable access to healthcare services?

Yes

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* 5. What are your most significant health concerns? Select all that apply.

Mobility

Vision/Hearing

Memory

Chronic Illness

Mental Health

Other (please specify)

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* 6. Do you engage in regular physical activity?

Yes

If Yes, what kind?

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* 7. Do you drive yourself?

Yes

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* 8. Do you have access to other transportation options? Select all that apply.

Public

Community Shuttles

Friends/Family

None

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* 9. How often do you feel socially isolated or lonely?

Often

Sometimes

Rarely

Never

Other (please specify)

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* 10. Are there enough social opportunities for seniors in your area?

Yes

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* 11. Would you participate in the following events? Select all that apply

Senior Center Activities

Support Groups

Technology Classes

Games Night

Volunteering

Other (please specify)

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* 12. Which of the following would you like more access to?

Meal delivery

Home repairs

In-home medical care

Financial assistance

Legal support

Other (please specify)

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* 13. What are the biggest challenges you face in daily living?

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* 14. Do you have access to a smartphone, computer, tablet or other similar technology?

Yes

If Yes, please list what technology you use.

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* 15. Do you feel confident using technology for the following? Please select all to which the answer is Yes.

Communication (email/video)

Online shopping

Healthcare (telehealth)

Banking

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* 16. Are you interesting in attending classes or support sessions on using digital devices?

Yes

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* 17. How often do you participate in activities such as puzzles, reading, learning something new? Please select one answer.

Daily

Weekly

Rarely

Never

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* 18. Would you be interested in brain health or memory workshops?

Yes

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* 19. If you were going to join a small group or attend a community program, what time is most convenient?

Morning (before noon)

Afternoon (noon to 4)

Evening (after 4 pm)

Other (please specify)

Community Needs Assessment Survey To better understand the needs, challenges, and preferences of adults 50+ in our community so that programs, services, and resources can be aligned to support quality of life.

Question Title

* 1. Basic Information (Optional and Confidential)

Question Title

* 2. Are you satisfied with your current housing?

Question Title

* 3. Do you have concerns about housing and living affordability? Mark all that apply.

Question Title

* 4. Do you have reliable access to healthcare services?

Question Title

* 5. What are your most significant health concerns? Select all that apply.

Question Title

* 6. Do you engage in regular physical activity?

Question Title

* 7. Do you drive yourself?

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* 8. Do you have access to other transportation options? Select all that apply.

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* 9. How often do you feel socially isolated or lonely?

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* 10. Are there enough social opportunities for seniors in your area?

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* 11. Would you participate in the following events? Select all that apply

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* 12. Which of the following would you like more access to?

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* 13. What are the biggest challenges you face in daily living?

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* 14. Do you have access to a smartphone, computer, tablet or other similar technology?

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* 15. Do you feel confident using technology for the following? Please select all to which the answer is Yes.

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* 16. Are you interesting in attending classes or support sessions on using digital devices?

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* 17. How often do you participate in activities such as puzzles, reading, learning something new? Please select one answer.

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* 18. Would you be interested in brain health or memory workshops?

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* 19. If you were going to join a small group or attend a community program, what time is most convenient?

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* 20. What is one thing that would most improve your life?

Community Needs Assessment Survey

To better understand the needs, challenges, and preferences of adults 50+ in our community so that programs, services, and resources can be aligned to support quality of life.