Social Isolation and Loneliness Community Free Event

EVENT INFORMATION

November 14, 2024
5:30 - 8:30 pm

AGENDA
6:00 - 7:00 All the Lonely People - Documentary by the Clowder Group
7:00 - 7:30 Panel
7:30 - 8:30 Social Hour

LOCATION
Country Inn and Suits Fort Atkinson
1650 Doris Dr, Fort Atkinson, WI 53538

Hor d'oeuvres provided, Free Soda and Water - Cash Bar Available

*Limited to the first 200 people

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* 1. Name

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* 2. Please supply your address

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* 3. Phone

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* 4. How did you hear about this event?

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* 5. Will you be able to attend the event?

Yes

Note: If you are bringing a guest, please have them register on their own.

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* 6. Additional comments?

INSTRUCTIONS: Please Indicate how often each of the statements below is descriptive of you.

UCLA LONELINESS SCALE VERSION 3

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* 7. How often do you feel that you are "in tune" with the people around you?

Never

Rarely

Sometimes

Often

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* 8. How often do you feel that you lack companionship?

Never

Rarely

Sometimes

Often

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* 9. How often do you feel that there is no one you can turn to?

Never

Rarely

Sometimes

Often

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* 10. How often do you feel alone?

Never

Rarely

Sometimes

Often

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* 11. How often do you feel part of a group of friends?

Never

Rarely

Sometimes

Often

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* 12. How often do you feel that you have a lot in common with the people around you?

Never

Rarely

Sometimes

Often

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* 13. How often do you feel that you are no longer close to anyone?

Never

Rarely

Sometimes

Often

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* 14. How often do you feel that your interests and ideas are not shared by those around you?

Never

Rarely

Sometimes

Often

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* 15. How often do you feel outgoing and friendly?

Never

Rarely

Sometimes

Often

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* 16. How often do you feel close to people?

Never

Rarely

Sometimes

Often

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* 17. How often do you feel left out?

Never

Rarely

Sometimes

Often

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* 18. How often do you feel that your relationships with others are not meaningful?

Never

Rarely

Sometimes

Often

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* 19. How often do you feel that no one really knows you?

Never

Rarely

Sometimes

Often

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* 20. How often do you feel isolated from others?

Never

Rarely

Sometimes

Often

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* 21. How often do you feel you can find companionship when you want it?

Never

Rarely

Sometimes

Often

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* 22. How often do you feel that there are people who really understand you?

Never

Rarely

Sometimes

Often

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* 23. How often do you feel shy?

Never

Rarely

Sometimes

Often

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* 24. How often do you feel that people are around you but not with you?

Never

Rarely

Sometimes

Often

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* 25. How often do you feel that there are people you can talk to?

Never

Rarely

Sometimes

Often

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* 26. How often do you feel that there are people you can turn to?

Never

Rarely

Sometimes

Often