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Please help us understand how the COVID-19 pandemic is impacting you by completing this ANONYMOUS survey.

Estimated time to complete: 5-10 minutes.

Select the best answer for each of the following questions:

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* How often do you utilize senior center services?

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* How long have you been visiting a senior center?

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

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* Which best describes who you live with?

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* Do you have a pet?

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* Which best describes where you live?

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* What is your zip code?

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* Do you have a disability?

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* Do you take 5 or more prescriptions and/or over-the-counter medicines a day?

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* A caregiver is someone who provides paid or unpaid support, even minimally, and can be a friend, family member, or professional. Do you rely on a caregiver?

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* Since the start of the pandemic, have you used any of the following services? (Check all that apply)

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* Are you a Veteran?

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* Please indicate your age:

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* Please indicate which gender you identify as:

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

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* What is your employment status?

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* What is your primary source of income?

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* What is your household's average monthly income?

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