1.What are some things, in your opinion, that Jayhawk could do to assist with the struggles you face with aging?

2.What is your greatest worry about aging? (Select one)

Personal health

Personal mobility

Social activity and relationships

Finances

Suitable housing

Nutrition

Suitable transportation

Other (please specify)

*3.AGE GROUP(Required.)

Below 50

50-59

60-69

70-79

80-89

Over 90

4.Gender

Male

Female

5.COUNTY

Douglas

Jefferson

Shawnee