* 1. Name:

* 2. Please add your email address to enter the drawing for a $100 gift card:

* 3. Check as many as apply:

* 4. How often do you come to the ACC?

* 5. When is the best time for services/programs/activities?

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Mornings
Afternoons
Evenings

* 6. How did you first learn about the ACC?

* 7. How do you hear about the ACC now?

* 8. What is your age?

* 9. What is your gender?

* 10. How do you get to the ACC?

* 11. If you have used one or more of these ACC services in the last year, please indicate how satisfied you were:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
AARP Mature Driving
AARP Tax Service
Caregiver Service
Information from Staff
Legal Clinic
Meals at the Center
Meals on Wheels
Medical Escort
Medical Lending
Medicare Help
Project Alert
Respite
Senior Companion
Support Group
Transportation

* 12. Have you attended one of the ACC Activities in the past year? Please check how satisfied you were:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
Bridge
Computer Learning
Creative Hands
Fitness Center
Friday Flicks
Friday Discussion Group
Jotting
Knitting
Lakewood Center Dress Rehearsals
Mah Jongg
Pinochle
Special Investment Group (SIG)
Solo Dinner
Quilting
Scrabble

* 13. Have you attended one of the ACC's special series in the past year? Please check how satisfied you were:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
Aging Mastery Program
Health Chats
Stressbusting for Family Caregivers
VIEWS Conversations on Aging

* 14. Have you attended a special event/game at the ACC? Please check how satisfied you were:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
National Senior Health and Fitness Day
Annual Volunteer Appreciation
"Off the Record"
"At the Hop"
Bingo
Bunco
Supper Club

* 15. Have you taken a trip with the ACC in the past year? Please rate how satisfied you were:

* 16. Please rate our current free amenities:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
Wi-Fi
Coffee
Tea
Water

* 17. Is there a refreshment you would like to see at the ACC?

* 18. Please rate the amenities for purchase at the ACC:

  Very Satisfied Satisfied Neutral Not Satisfied N/A
Massage
Baked goods (cookies, cake, bread at the front desk)
Salad Bar

* 19. Would you be interested in other amenities for purchase?

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