The Bloomington-Normal Leadership Task Force, led by the East Central Illinois Area Agency on Aging and University of Illinois Extension, is working to secure the Dementia Friendly America (DFA) designation. This initiative joins a national network aimed at enhancing community support for residents living with dementia and their caregivers.

Your input is needed to support dementia care in our community. Please complete this brief, anonymous survey to help us develop an action plan for improving resources for individuals with dementia and their caregivers in Bloomington-Normal and surrounding areas. All are welcome to participate.

1.As a member of the Bloomington-Normal community, what group(s) do you most identify with (check all that apply)?

Banks & Financial Services

Business

Community-Based Services

Bloomington-Normal Resident

Education

Faith Community

First Responder (Fire, Police)

Health Care Provider

Housing

Legal Services

Library

Local Government

Long-Term Residential & Specialty Care

Neighborhood Association

Transportation

Unpaid Caregiver (Family, Friend, Neighbor)

Paid Caregiver

Other (please specify)

*2.Are you an unpaid family caregiver to a person living with dementia?(Required.)

Yes

No

*3.Have you been diagnosed with dementia?(Required.)

Yes

No

Prefer not to answer

*4.Dementia is part of normal aging?(Required.)

True

False

Unsure