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* 1. Which site do you attend?

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What is your race?

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* 5. Do you live...

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* 6. How did you learn about our programs and activities?

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* 7. How would you rate the classes you participate in at this site? If you do not participate please check NA.

  Excellent Very good Good Fair Poor NA
Healthy Lifestyle
Senior Pathways
Yard Art
Painting Class
Exercise Class

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* 8. How satisfied are you with the days/ times the classes are offered?

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* 9. Do you find the staff courteous and professional?

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* 10. Are you aware that you can make a donation towards our programs if you wish?

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* 11. Has your life changed in any way since you started participating in the classes? Because of your participation do you feel that:

  Most of the time Sometimes Rarely
You are able to socialize more
You have something to look forward to
You are more physically active
You learn about healthy lifestyles

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* 12. Overall, are you satisfied with the classes and activities?

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* 13. Additional comments:

T