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Commission on Aging and Disabilities
Community Survey
1.
Name: (Optional)
2.
Address: (Optional)
3.
Phone: (Optional)
4.
E-mail: (Optional)
5.
Are you familiar with the Arnold Commission on Aging and Disabilities?
Yes
No
6.
How many people living in your household over the age of 65?
7.
How many people living in your household who have a disability?
8.
Is anyone in your household a veteran?
Yes
No
9.
Does the City of Arnold have adequate disability parking?
Yes
No
10.
Are you aware of the JC Express Arnold service?
Yes
No
11.
Have you or do you intend to use JC Express?
Yes
No
12.
Has there been a time when you were unable to access public services within the city of Arnold?
Yes
No
If yes, please explain
13.
Do you receive services from any support agencies?
Yes
No
If yes, please explain
14.
Are there services that you would benefit from?
Yes
No
If yes, please explain
15.
Do you have any suggestions on how to make the city of Arnold more user friendly for the aging or disabled population?
Yes
No
If yes, please explain