This is your opportunity to have input on the State Plan on Aging. This survey will provide the West Virginia Bureau of Senior Services with valuable input and advice for West Virginia's State Plan on Aging. Please take the time to complete the survey, it should only take a few minutes.

We appreciate your input and time.

Thank you.

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* 1. What is your first name?

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* 2. What is your county of residence?

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* 3. What is your Zip Code?

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* 4. What is your age?

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* 5. How do you identify? (Check all that apply)

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* 6. What do you believe are the most critical/difficult issues faced by West Virginia Seniors? (Check all that apply)

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* 7. What services and supports are most important to you as a West Virginia senior?

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* 8. Are you familiar with West Virginia Adult Protective Services?

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* 9. Are you familiar with the WV Elder Abuse Hotline -- 1800-352-6513?

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* 10. If you are a caregiver, what are your most important needs?

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* 11. WV State Plan Goal #1: Provide older adults and other interested parties with access to accurate and dependable information to assist them to make informed decisions regarding services and supports for older individuals.

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* 12. WV State Plan Goal #2: Support and empower older adults to continue to remain in the least restrictive environment.

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* 13. WV State Plan Goal #3: Enable and empower older adults to stay active, healthy and manage medical conditions.

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* 14. WV State Plan Goal #4: Ensure the dignity and rights of older West Virginians and reduce abuse and neglect (physical, mental, financial, etc.).

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* 15. Please share any additional comments or suggestions you may have on issues or concerns for seniors.

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