Racine County Adult Enrichment Center Survey

Section One: In this section, we’d like to explore the kinds of adult enrichment programs and services that you would likely participate in.

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* 1. Please rank the following program areas by level of your interest:

	Not Interested	Neutral	Somewhat Interested	Interested	Very Interested
Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes	Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes Not Interested	Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes Neutral	Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes Somewhat Interested	Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes Interested	Educational Activities such as: Book Club, Learning a Foreign Language, Computer Lab, Caregiver Classes Very Interested
Entertainment Activities such as: Movies, Live Music, Performers	Entertainment Activities such as: Movies, Live Music, Performers Not Interested	Entertainment Activities such as: Movies, Live Music, Performers Neutral	Entertainment Activities such as: Movies, Live Music, Performers Somewhat Interested	Entertainment Activities such as: Movies, Live Music, Performers Interested	Entertainment Activities such as: Movies, Live Music, Performers Very Interested
Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong	Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong Not Interested	Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong Neutral	Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong Somewhat Interested	Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong Interested	Recreational Activities such as: Billiards, Euchre, Table Tennis, Pickle Ball, Bridge, Mahjong Very Interested
Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc.	Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc. Not Interested	Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc. Neutral	Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc. Somewhat Interested	Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc. Interested	Creative Activities such as: Painting, sketching, pottery, wood working, weaving, etc. Very Interested
Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes.	Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes. Not Interested	Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes. Neutral	Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes. Somewhat Interested	Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes. Interested	Health and Wellness Activities such as: Yoga, Dance, Cooking & Nutrition, Healthy Living classes. Very Interested

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* 2. Share any comments about the above programming ideas.

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* 3. Are there other programs or services that you’d like to see an Adult Enrichment Center offer to better meet the needs of our 55 and older residents?

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* 4. Would you be interested in volunteering to lead/co-lead a workshop and/or activity at a Racine County Adult Enrichment Center?

Yes: Please tell us what kinds of activities and/or workshops you’d be interested in leading.

Section Two: In this section, we’d like to hear your thoughts about aspects of accessibility to a Racine County Adult Enrichment Center.

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* 5. Would you attend an adult enrichment center that offers programming for residents ages 55 years and older?

Yes

No (If no, please tell us if there are any barriers to your being able to attend. What are the barriers?)

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* 6. Would you prefer a central location or multiple locations for an adult enrichment center?

Central location with a variety of services and programming

Multiple locations with specific services and programming by location

Other (please specify)

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* 7. Would you need transportation to an adult enrichment center?

Yes

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* 8. How far are you willing to travel to an adult enrichment center?

Under 5 miles

5-10 miles

More than 10 miles

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* 9. What time of the day would you most likely attend programs at an adult enrichment center?

Morning (9:00 a.m. - noon)

Afternoon (noon - 5:00 p.m.)

Early evening (5:00 - 8:00 p.m.)

Section Three: In this section, we’re asking questions related to funding the programming at a Racine County Adult Enrichment Center.

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* 10. Would you be willing to pay a monthly membership for an adult enrichment center?

Yes

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* 11. Whether or not you are a center member, are you willing to pay an additional fee for classes/workshops/activities? (For example, would you pay a $20 fee for a class to cover materials?)

Yes

Section Four: In this section, we are collecting demographic information of those who fill out the survey. This information will be helpful to us in seeking public and private grants.

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* 12. Please indicate your age group:

55-64

65-74

75 or older

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* 13. Please indicate your race:

White or Caucasian, Not Hispanic

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Two or More Races

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* 14. Please tell us your zip code:

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* 15. Please provide any additional feedback here that we did not ask about that would be important in the development of a Racine County Adult Enrichment Center.