* 1. In what city/town do you live?

* 2. In your opinion, what are programs and services that would benefit caregivers the most? 

* 3. In your opinion, what are the gaps in services for senior citizens and people with disabilities in your community?

* 4. Would you be interested in serving on the LifeStream Advisory Council - providing input on how to best meet the needs of seniors and people with disabilities in East Central Indiana? 

* 5. If you answered yes to the question above, please provide your name and the best way to reach you (phone/email), and we will be in contact with you shortly.

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