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* 1. What county do you live in?

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* 2. What city or town do you live in?

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* 3. What decade were you born?

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* 4. Do you know what an Ombudsman is?

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* 5. Do you know how to choose a long-term care facility for yourself or a loved one?

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* 6. Do you know the different types of long-term care facilities?

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* 7. Do you know how to file a complaint about a facility?

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* 8. Have you heard of the Residents' Bill of Rights?

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* 9. Do you know what Evidence-Based Health Promotions are?

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* 10. Do you know who offers Evidence-Based Health Promotion programs in your area?

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* 11. Are you caring for a loved one or friend?

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* 12. How many hours per week do you care for an individual?

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* 13. Do you care for someone with cognitive impairment (dementia, Alzheimer's Disease, traumatic brain injury)?

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* 14. Do you know who to contact for community support programs for caregivers (support groups, education, information, and resources)?

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* 15. Do you know where your local senior center is?

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* 16. Do you participate in activities at the senior center?

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* 17. Did you know you can get a ride to the senior center?

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* 18. Do you know who to call to assist with transportation?

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* 19. Have you eaten a meal at the senior center?

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* 20. If you need help to stay in your home, do you know who to call in your community for assistance/resources?

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* 21. If you have questions about aging or services, do you know who to call in your community?

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* 22. Do you deliver home-delivered meals?

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* 23. Do you volunteer?

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* 24. Do you volunteer at your senior center?

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