Snohomish County COVID-19 Seniors Survey

For translation assistance, please contact Kelsey.Bang-Olsen@snoco.org.

Help us understand how the COVID-19 pandemic is impacting you by completing this ANONYMOUS survey by January 15, 2021. Please select the best answer for each of the following questions:

Question Title

* Prior to the pandemic, how long have you been visiting a senior center?

Never

Less than 1 year

1 to 5 years

6 to 10 years

Over 10 years

Question Title

* In the past month, how often have you left home?

Daily

2 to 4 times per week

1 time per week

1 to 3 times per month

1 times per month

Less than once per month

Question Title

* Which best describes who you live with?

I live alone

I live with my partner

I live with family

I live with a roommate

Other (please specify)

Question Title

* Do you have a pet?

Yes

Question Title

* Do you live in Snohomish County?

Yes

Question Title

* What is your zip code?

Question Title

* Do you have a disability?

Yes

Question Title

* Please indicate which gender you identify as:

Male

Female

Transgender

Other (please specify)

Question Title

* Please indicate which race and/or ethnicity you identify as:

Race

Ethnicity

Question Title

* Please indicate your age:

18-59 years old

60-69 years old

70-79 years old

80-89 years old

90 years or older