Money Follows the Person Participant Survey Question Title * 1. Relationship to participant: (Please choose one) Self Spouse/Significant Other Family Member Friend/Neighbor Division of Aging staff with participant Other Question Title * 2. Age of Money Follows the Person participant: Question Title * 3. Gender of Money Follows the Person participant: Male Female Question Title * 4. What is your or the Money Follows the Person participant’s local Area Agency on Aging or Independent Care Agency? If you are unsure please select N/A. Area 1: Northwest Indiana Community Action Corporation - Includes counties: Jasper, Lake, Newton, Porter, Pulaski, Starke Area 2: REAL Services Inc. - Includes counties: Elkhart, Kosciusko, LaPorte, Marshall, St. Joseph Area 3: Aging and In-Home Services of Northeast Indiana Inc. - Includes counties: Adams, Allen, DeKalb, Huntington, LaGrange, Noble, Steuben, Wells, Whitely Area 4: Area IV Agency on Aging & Community Action Programs, Inc. - Includes counties: Benton, Carroll, Clinton, Fountain, Montgomery, Tippecanoe, Warren, White Area 5: Area Five Agency on Aging & Community Services Inc. - Includes counties: Cass, Fulton, Howard, Miami, Tipton, Wabash Area 6: LifeStream Services Inc. - Includes counties Blackford, Delaware, Grant, Henry, Jay, Madison, Randolph Area 7: West Central Indiana Economic Development District, Inc. - Includes counties: Clay, Parke, Putnam, Sullivan, Vermillion, Vigo Area 8: CICOA Aging & In-Home Solutions - Includes counties: Boone, Hancock, Hamilton, Hendricks, Johnson, Marion, Morgan, Shelby Area 9: LifeStream Services Inc. - Includes counties: Fayette, Franklin, Rush, Union, Wayne Area 10: Area 10 Agency on Aging - Includes counties: Monroe and Owen Area 11: Thrive Alliance - Includes counties: Bartholomew, Brown, Decatur, Jackson, Jennings Area 12: LifeTime Resources Inc. - Includes counties: Dearborn, Jefferson, Ohio, Ripley, Switzerland Area 13: Generations Vincennes University Statewide Services - Includes counties Daviess, Dubois, Greene, Knox, Martin, Pike Area 14: Lifespan Resources Inc. - Includes counties: Clark, Floyd, Harrison, Scott Area 15: Hoosier Uplands/Area 15 Agency on Aging and Disability Services - Includes counties: Crawford, Lawrence, Orange, Washington Area 16: SWIRCA & More - Includes counties: Gibson, Perry, Posey, Spencer, Vanderburgh, Warrick N/A Independent Care Agency (please specify) Next