2017 Home for the Holidays Survey If your agency has a program specifically for people with dementia or their caregivers, please let us know. We'd love to highlight YOUR work throughout this year's Home for the Holidays campaign.We'd like your agency to participate in this year's Home for the Holidays campaign, but we need YOU to answer a few questions to help us prepare. Question Title * 1. In 2016, has your agency received MORE, THE SAME AMOUNT, or FEWER requests for assistance from people with dementia and/or their caregivers? More Same Fewer Question Title * 2. If your agency has noticed an increase in the number of inquiries about supportive services for individuals living with dementia, please estimate for us the size/percentage of the increase. 0 to 5% 5% to 10% 11% to 25% 26% to 50% 51% to 75% 76% to 100% Question Title * 3. Does your agency have a program that that is targeted toward individuals with dementia and/or their caregivers? Yes No Question Title * 4. How many years has your program been in existence? Question Title * 5. Are you or is someone at your agency willing to speak with the media to discuss your agency’s dementia-focused programming? Yes No Question Title * 6. Use the space below to tell us about your program. Question Title * 7. Contact Information First Name Last Name Agency E-mail Address Phone Number Thank you for taking the time to tell us how your AAA or Title VI Aging Program is working to help people living with dementia and their caregivers. Your input will help the n4a communications team improve the tools and resources we provide to n4a members. Thanks for your support and never hesitate to reach out to us with ideas, questions or concerns. Joellen Leavelle, Communications Director, jleavelle@n4a.orgCharlie Carroll, Senior Communications Associate, ccarroll@n4a.org(202) 872-0888 Done
