AmeriCorps Seniors Perceived Health Survey

Question Title

* 2. If you are already a RSVP Volunteer, how long have you been serving?

Less than 1 year

1-2 years

3-4 years

5-9 years

10-14 years

15-19 years

20 years or more

I am a new RSVP Volunteer

Question Title

* 3. Have you spent any time in the last 12 months doing volunteer work for religious, educational, health-related or other charitable organizations not associated with or in addition to your RSVP assignment(s)?

Yes

Question Title

* 4. Which group best reflects your age today?

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90-94

95-99

100 or older

Question Title

* 5. Gender

Male

Female

Prefer not to answer

Question Title

* 6. Race:

White/Caucasian

Black/African American

Asian, Native Hawaiian, Pacific Islander

American Indian or Alaskan Native

Question Title

* 7. Ethnicity:

Not Hispanic or Latino

Hispanic or Latino

Not sure

Question Title

* 8. Education:

Less than High School

High School or GED

Less than BA Degree

BA Degree or Higher

Question Title

* 9. Estimated Household Income

$0 - $19,999

$20,000 - $29,000

$30,000 - $39,000

$40,000 - $49,000

$50,000 - $69,000

$70,000 or more

Prefer not to answer

Question Title

* 10. Marital Status:

Married/Partner

Widowed

Single/Other

Question Title

* 11. Do you live alone or with someone?

I live alone.

I live with someone (spouse, partner, child, or other).

Question Title

* 12. Did you serve in a branch of the military?

Yes

Question Title

* 13. How would you rate your health?

	Excellent Health	Very Good Health	Good Health	Fair Health	Poor Health
Health Status Self Assessment	Health Status Self Assessment Excellent Health	Health Status Self Assessment Very Good Health	Health Status Self Assessment Good Health	Health Status Self Assessment Fair Health	Health Status Self Assessment Poor Health

Question Title

* 14. Because of a health problem do you have any difficulty with walking one block?

	Yes	No	Can't Do	Don't Do	I don't know
Mobility	Mobility Yes	Mobility No	Mobility Can't Do	Mobility Don't Do	Mobility I don't know

Question Title

* 15. Please think about your life-as-a-whole. How satisfied are you with it? Are you satisfied or not satisfied?

	Completely Not Satisfied	Not Very Satisfied	Somewhat Satisfied	Very Satisfied	Completely Satisfied
General Life Satisfaction	General Life Satisfaction Completely Not Satisfied	General Life Satisfaction Not Very Satisfied	General Life Satisfaction Somewhat Satisfied	General Life Satisfaction Very Satisfied	General Life Satisfaction Completely Satisfied

Question Title

* 16. Please think about your volunteering experiences with RSVP. How satisfied are you with your volunteer assignments? Are you satisfied or not satisfied?

	Completely Not Satisfied	Not Very Satisfied	Somewhat Satisfied	Very Satisfied	Completely Satisfied	Have not volunteered with RSVP yet
RSVP Volunteering Satisfaction	RSVP Volunteering Satisfaction Completely Not Satisfied	RSVP Volunteering Satisfaction Not Very Satisfied	RSVP Volunteering Satisfaction Somewhat Satisfied	RSVP Volunteering Satisfaction Very Satisfied	RSVP Volunteering Satisfaction Completely Satisfied	RSVP Volunteering Satisfaction Have not volunteered with RSVP yet

Question Title

* 17. Do you feel that your volunteering experiences have anything to do how satisfied you feel about your life-as-a-whole?

Yes

Sometimes

Question Title

* 18. Do you feel that there are people that you are close to?

	Never	Hardly ever	Some of the time	Often	Always
Connectivity	Connectivity Never	Connectivity Hardly ever	Connectivity Some of the time	Connectivity Often	Connectivity Always

Question Title

* 19. Do you feel that you can do the things you want to?

	Strongly Disagree	Somewhat Disagree	Slightly Disagree	Slightly Agree	Somewhat Agree	Strongly Agree
Self-Efficacy	Self-Efficacy Strongly Disagree	Self-Efficacy Somewhat Disagree	Self-Efficacy Slightly Disagree	Self-Efficacy Slightly Agree	Self-Efficacy Somewhat Agree	Self-Efficacy Strongly Agree

Question Title

* 20. Do you feel that you lack companionship?

	Never	Hardly Ever	Some of the time	Often	Always
Companionship	Companionship Never	Companionship Hardly Ever	Companionship Some of the time	Companionship Often	Companionship Always

Question Title

* 21. What are some of the reasons that motivate you to want to volunteer?

	Not at all	Rarely	Some of the time	Most of the time	All of the time
Help Another Person/Children	Help Another Person/Children Not at all	Help Another Person/Children Rarely	Help Another Person/Children Some of the time	Help Another Person/Children Most of the time	Help Another Person/Children All of the time
Earn Extra Money	Earn Extra Money Not at all	Earn Extra Money Rarely	Earn Extra Money Some of the time	Earn Extra Money Most of the time	Earn Extra Money All of the time
Keep Busy/Fill My Time	Keep Busy/Fill My Time Not at all	Keep Busy/Fill My Time Rarely	Keep Busy/Fill My Time Some of the time	Keep Busy/Fill My Time Most of the time	Keep Busy/Fill My Time All of the time
Learn Something New	Learn Something New Not at all	Learn Something New Rarely	Learn Something New Some of the time	Learn Something New Most of the time	Learn Something New All of the time
Make Me Feel Better	Make Me Feel Better Not at all	Make Me Feel Better Rarely	Make Me Feel Better Some of the time	Make Me Feel Better Most of the time	Make Me Feel Better All of the time
Make New Friends	Make New Friends Not at all	Make New Friends Rarely	Make New Friends Some of the time	Make New Friends Most of the time	Make New Friends All of the time
Get More Experience	Get More Experience Not at all	Get More Experience Rarely	Get More Experience Some of the time	Get More Experience Most of the time	Get More Experience All of the time
Learn a New Skill or Hobby	Learn a New Skill or Hobby Not at all	Learn a New Skill or Hobby Rarely	Learn a New Skill or Hobby Some of the time	Learn a New Skill or Hobby Most of the time	Learn a New Skill or Hobby All of the time
Have a Sense of Accomplishment	Have a Sense of Accomplishment Not at all	Have a Sense of Accomplishment Rarely	Have a Sense of Accomplishment Some of the time	Have a Sense of Accomplishment Most of the time	Have a Sense of Accomplishment All of the time
Improve My Community	Improve My Community Not at all	Improve My Community Rarely	Improve My Community Some of the time	Improve My Community Most of the time	Improve My Community All of the time
Learn About Myself	Learn About Myself Not at all	Learn About Myself Rarely	Learn About Myself Some of the time	Learn About Myself Most of the time	Learn About Myself All of the time

Question Title

* 22. How did you learn about RSVP?

From a friend

Word of mouth

Printed brochure or poster

Newspaper, social media, radio or other media source

Community outreach events

Church

Other (please specify)

Question Title

* 1. I am a...

Question Title

* 2. If you are already a RSVP Volunteer, how long have you been serving?

Question Title

* 3. Have you spent any time in the last 12 months doing volunteer work for religious, educational, health-related or other charitable organizations not associated with or in addition to your RSVP assignment(s)?

Question Title

* 4. Which group best reflects your age today?

Question Title

* 5. Gender

Question Title

* 6. Race:

Question Title

* 7. Ethnicity:

Question Title

* 8. Education:

Question Title

* 9. Estimated Household Income

Question Title

* 10. Marital Status:

Question Title

* 11. Do you live alone or with someone?

Question Title

* 12. Did you serve in a branch of the military?

Question Title

* 13. How would you rate your health?

Question Title

* 14. Because of a health problem do you have any difficulty with walking one block?

Question Title

* 15. Please think about your life-as-a-whole. How satisfied are you with it? Are you satisfied or not satisfied?

Question Title

* 16. Please think about your volunteering experiences with RSVP. How satisfied are you with your volunteer assignments? Are you satisfied or not satisfied?

Question Title

* 17. Do you feel that your volunteering experiences have anything to do how satisfied you feel about your life-as-a-whole?

Question Title

* 18. Do you feel that there are people that you are close to?

Question Title

* 19. Do you feel that you can do the things you want to?

Question Title

* 20. Do you feel that you lack companionship?

Question Title

* 21. What are some of the reasons that motivate you to want to volunteer?

Question Title

* 22. How did you learn about RSVP?