Eden Area Village Services Survey

	very	not much	not at all
Information and referrals to senior and community service providers	Information and referrals to senior and community service providers very	Information and referrals to senior and community service providers not much	Information and referrals to senior and community service providers not at all
Transportation to medical appointments, shopping, social events	Transportation to medical appointments, shopping, social events very	Transportation to medical appointments, shopping, social events not much	Transportation to medical appointments, shopping, social events not at all
Household assistance with small repairs, occasional yard work, or light housework	Household assistance with small repairs, occasional yard work, or light housework very	Household assistance with small repairs, occasional yard work, or light housework not much	Household assistance with small repairs, occasional yard work, or light housework not at all
Social activities (like lunches, coffee, theater nights, or day trips)	Social activities (like lunches, coffee, theater nights, or day trips) very	Social activities (like lunches, coffee, theater nights, or day trips) not much	Social activities (like lunches, coffee, theater nights, or day trips) not at all
Educational programs (like lectures and films)	Educational programs (like lectures and films) very	Educational programs (like lectures and films) not much	Educational programs (like lectures and films) not at all
Wellness programs (like fitness classes or home safety evaluations)	Wellness programs (like fitness classes or home safety evaluations) very	Wellness programs (like fitness classes or home safety evaluations) not much	Wellness programs (like fitness classes or home safety evaluations) not at all
Help with computers and other electronics	Help with computers and other electronics very	Help with computers and other electronics not much	Help with computers and other electronics not at all

very

not much

not at all

Information and referrals to senior and community service providers

Information and referrals to senior and community service providers very

Information and referrals to senior and community service providers not much

Information and referrals to senior and community service providers not at all

Transportation to medical appointments, shopping, social events

Transportation to medical appointments, shopping, social events very

Transportation to medical appointments, shopping, social events not much

Transportation to medical appointments, shopping, social events not at all

Household assistance with small repairs, occasional yard work, or light housework

Household assistance with small repairs, occasional yard work, or light housework very

Household assistance with small repairs, occasional yard work, or light housework not much

Household assistance with small repairs, occasional yard work, or light housework not at all

Social activities (like lunches, coffee, theater nights, or day trips)

Social activities (like lunches, coffee, theater nights, or day trips) very

Social activities (like lunches, coffee, theater nights, or day trips) not much

Social activities (like lunches, coffee, theater nights, or day trips) not at all

Educational programs (like lectures and films)

Educational programs (like lectures and films) very

Educational programs (like lectures and films) not much

Educational programs (like lectures and films) not at all

Wellness programs (like fitness classes or home safety evaluations)

Wellness programs (like fitness classes or home safety evaluations) very

Wellness programs (like fitness classes or home safety evaluations) not much

Wellness programs (like fitness classes or home safety evaluations) not at all

Help with computers and other electronics

Help with computers and other electronics very

Help with computers and other electronics not much

Help with computers and other electronics not at all

Question Title

* 2. What services are important to you that were not mentioned previously.

Question Title

* 3. How might you support Eden Area Village?

	Definitely	Maybe	No
Volunteer my time and skills	Volunteer my time and skills Definitely	Volunteer my time and skills Maybe	Volunteer my time and skills No
Provide financial support	Provide financial support Definitely	Provide financial support Maybe	Provide financial support No
Participate in program development (write grants, raise funds, help set up 501 (c)(3))	Participate in program development (write grants, raise funds, help set up 501 (c)(3)) Definitely	Participate in program development (write grants, raise funds, help set up 501 (c)(3)) Maybe	Participate in program development (write grants, raise funds, help set up 501 (c)(3)) No
Participate in leadership as a committee member	Participate in leadership as a committee member Definitely	Participate in leadership as a committee member Maybe	Participate in leadership as a committee member No

Question Title

* 4. What do you think would be a reasonable ANNUAL fee for membership in an organization that provides the above-mentioned services?

$500 and up

$250-$400

$100-$250

$50-$100

$50 or less

None

Question Title

* 5. We would like to keep in touch with you. Please enter your name and contact information if interested.

Name

Phone

Age

Question Title

* 1. Which supportive services are most important to you?

Question Title

* 2. What services are important to you that were not mentioned previously.

Question Title

* 3. How might you support Eden Area Village?

Question Title

* 4. What do you think would be a reasonable ANNUAL fee for membership in an organization that provides the above-mentioned services?

Question Title

* 5. We would like to keep in touch with you. Please enter your name and contact information if interested.