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* 1. How would you rate your community as a place to live as people age? (select one)

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* 2. What about your community makes it a good place for people to live as they age? (select two)

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* 3. What would make the community a better place for people to live as they age?

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* 4. How confident are you that you will be able to continue living in your current residence for as long as you would like? (select one)

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* 5. What are some reasons you might consider moving from your current home (check all that apply)

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* 6. Do you feel that there are enough social activities in your community for older adults?

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* 7. What activities would you like to see that are not currently available?

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* 8. If you don’t currently go to a senior center, that is because…

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* 9. Do you currently volunteer?

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* 10. Do you have internet at home?

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* 11. Is there anything else you would like to share about making your community a better place to age in place?

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* 12. Where do you live? (City/Town/Village)

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* 13. How old are you?

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* 14. How do you identify?

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* 15. What is your race and/or ethnicity?

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* 16. Are you of Hispanic or Latino/a origin?

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