1.What county do you reside in?

Bartow

Catoosa

Chattooga

Dade

Fannin

Floyd

Gilmer

Gordon

Haralson 

Murray

Paulding

Pickens

Polk 

Walker 

Whitfield

Other (please specify)

2.What is your age?

under 60

60 - 69

70 - 79

80 - 89

over 90

3.Which best describes you?

Caregiver/Family Member

Older Adult

Person With Disability

Service Provider/Community Partner

Other (please specify)

4.What is the best way for you to learn about services. Select up to three (3).

Doctor's Office/Hospital

Faith Community

Family or Freinds

Newspaper, Radio or Local Television

Senior Center

Social Media

Telephone

Website or Internet Search

Other (please specify)

5.Please select the FIVE services most needed in your community.

Adult Day Services

Alzheimer's and Dementia Services

Behavioral or Mental Health Services

Caregiver Support and Education

Congregate Meals/Senior Center Meals

Health and Wellness Programs

Home Delivered Meals

Home Modifications and Accessibility Improvements

Homemaker or Personal Care Services

Housing Assistance

Legal Assistance

Medicare, Insurance and Benefits Assistance

Minor Home Repairs

Respite Care/Caregiver Relief

Social Connection or Friendly Visiting

Technology or Internet Access

Transportation for Errands and Activities

Transportation for Medical Appointments

Other (please specify)