survey Aging in Community - Three Rivers 12 SURVEY QUESTIONS Aging in Community-Three Rivers is a local non-profit organization of volunteers dedicated to connecting elders with helping hands. Will you help us better understand your needs and interests by completing this brief survey? You may respond anonymously, but if you wish to receive feedback, please complete the information at the bottom of the page. Your responses are strictly confidential. If you have any questions, call Grace Klassen at (559) 465-4666. We appreciate your time and candid input! 1. What resources for seniors do you use in Three Rivers? 2. What services for seniors are missing in Three Rivers? 3. What social organizations do you enjoy in Three Rivers? 4. Do you need help with transportation?YesNo- Are you able to give rides to others?YesNo5. Are you willing to be interviewed and share your life story for our library collection called Dynamic Lives?YesNo6. Would you like to contacted by a volunteer - “friendly visitor” or phone caller for social time periodically?YesNo- Would you like to become a “friendly visitor” or phone caller to other seniors in our community?YesNo7. Are you interested in attending a free afternoon movie?YesNo- Do you need a ride?YesNo- Would you be able to provide a ride for a senior?YesNo- What movies would you like to see? 8. What topics are you interested in exploring through seminars? (Check all that apply) How to navigate the medical system Issues related to aging in place Information about dementia/Alzheimer’s disease How to avoid scams Financial options for elders Computer operations/management Technology updates for computers/phones Health and well being Care giving concerns Other9. Do you or a family member need care giver support?YesNo10. If needed, what kind of help could you use at home? 11. Would you or a loved one use an adult day program for seniors in Three Rivers?YesNo12. What skill or talent are you willing to share? Additional Comments/Questions Name: (optional)Mailing Address: (optional) Phone: (optional)Email: (optional)
