Activity Center Area Plan 2019 Question Title * 1. Have you ever used SWIRCA & More services? Yes No Question Title * 2. If you answered yes to question #1, what services have you used? Meals Attend events Activity Center Information and referral Case Management Other (please specify) Question Title * 3. How do you stay informed about events happening in your community? Computer/websites Facebook Printed literature TV Newspaper Word of mouth Maturity Journal Other (please specify) Question Title * 4. How satisfied are you with activities provided by SWIRCA & More? (1 being NOT satisfied 5 being VERY satisfied) 1 2 3 4 5 Exercise Classes Exercise Classes 1 Exercise Classes 2 Exercise Classes 3 Exercise Classes 4 Exercise Classes 5 Wellness Center Wellness Center 1 Wellness Center 2 Wellness Center 3 Wellness Center 4 Wellness Center 5 Special Events (ie: dances, outings) Special Events (ie: dances, outings) 1 Special Events (ie: dances, outings) 2 Special Events (ie: dances, outings) 3 Special Events (ie: dances, outings) 4 Special Events (ie: dances, outings) 5 Social Activities (ie: bingo, pokeno, cards) Social Activities (ie: bingo, pokeno, cards) 1 Social Activities (ie: bingo, pokeno, cards) 2 Social Activities (ie: bingo, pokeno, cards) 3 Social Activities (ie: bingo, pokeno, cards) 4 Social Activities (ie: bingo, pokeno, cards) 5 Educational programs Educational programs 1 Educational programs 2 Educational programs 3 Educational programs 4 Educational programs 5 Question Title * 5. What activities would you like to see offered at SWIRCA & More? Question Title * 6. What prevents you from using SWIRCA & More’s Activity Center more than you do? Time Grandkids Transportation Other commitments Job Not interested Other (please specify) Question Title * 7. Regarding activities, how important are the following to you: (1 being NOT important 5 being VERY important) 1 2 3 4 5 Meeting new friends Meeting new friends 1 Meeting new friends 2 Meeting new friends 3 Meeting new friends 4 Meeting new friends 5 Having transportation to the center Having transportation to the center 1 Having transportation to the center 2 Having transportation to the center 3 Having transportation to the center 4 Having transportation to the center 5 Flexible dining times Flexible dining times 1 Flexible dining times 2 Flexible dining times 3 Flexible dining times 4 Flexible dining times 5 Exercise room Exercise room 1 Exercise room 2 Exercise room 3 Exercise room 4 Exercise room 5 Case management services Case management services 1 Case management services 2 Case management services 3 Case management services 4 Case management services 5 Physical atmosphere Physical atmosphere 1 Physical atmosphere 2 Physical atmosphere 3 Physical atmosphere 4 Physical atmosphere 5 Support groups Support groups 1 Support groups 2 Support groups 3 Support groups 4 Support groups 5 Social Activities Social Activities 1 Social Activities 2 Social Activities 3 Social Activities 4 Social Activities 5 Group Outings Group Outings 1 Group Outings 2 Group Outings 3 Group Outings 4 Group Outings 5 Trips and travel opportunities Trips and travel opportunities 1 Trips and travel opportunities 2 Trips and travel opportunities 3 Trips and travel opportunities 4 Trips and travel opportunities 5 Handyman Services Handyman Services 1 Handyman Services 2 Handyman Services 3 Handyman Services 4 Handyman Services 5 Knowledgeable staff Knowledgeable staff 1 Knowledgeable staff 2 Knowledgeable staff 3 Knowledgeable staff 4 Knowledgeable staff 5 Question Title * 8. What changes can SWIRCA & More make to increase your level of participation with their events and activities? Question Title * 9. How do you prefer to pay for services and/or activities? Annual membership fee Per activity or program Question Title * 10. When would you most likely participate in activities such as those provided by SWIRCA & More? Please rank as 1 being your top choice 6 being your least likely time you would participate. 1 2 3 4 5 6 7 – 9 am weekdays 1 2 3 4 5 6 9-12 am weekdays 1 2 3 4 5 6 12-4 pm weekdays 1 2 3 4 5 6 4-8 pm weekdays 1 2 3 4 5 6 9-12 am Saturday 1 2 3 4 5 6 Any weekend hours Question Title * 11. Where would you most likely visit a meal site? Please rank as 1 being your top choice and 7 being your least favorite. 1 2 3 4 5 6 7 Activity Center 1 2 3 4 5 6 7 Restaurant 1 2 3 4 5 6 7 Union Hall 1 2 3 4 5 6 7 Club (elks, lions) 1 2 3 4 5 6 7 Church 1 2 3 4 5 6 7 Apartment building/clubhouse 1 2 3 4 5 6 7 Grocery Store Question Title * 12. Are you aware that SWIRCA & More has an ADRC (Aged & Disabled Resource Center) to help individuals navigate community services to help meet their needs to remain independent in their homes? Yes No Question Title * 13. Do you feel that there are adequate transportation options for the elderly & disabled in our community? Yes No Question Title * 14. What additional services could SWIRCA provide to aid the Aged & Disabled in our community? Question Title * 15. Are you worried that in the next 2 months, you may not have stable housing? Yes No Question Title * 16. In the last 12 months, have you ever had to go without health care because you didn’t have a way to get there? Yes No Question Title * 17. What zip code do you live in? Question Title * 18. What is your age range? Under 50 51 -60 61-70 71-80 81 or older Question Title * 19. Gender Male Female Other Question Title * 20. If willing, please share your story of how SWIRCA & More services has made a difference for you. Done
