SurveyMonkey Powered Online Survey

Thank you for answering these questions. Your feedback will help us to improve our programs.

This survey is being distributed in person AND to participants who have provided their emails.

If you have taken this survey in the last 6 months, please do NOT take it again. If you are not sure, please complete it now.

For information about the Senior Center or this survey, contact ocseniorcenters@orangecountync.gov.

Please answer these questions about your participation at a Senior Center in the past 6 months.

Question Title

* 1. Please provide this information.

Today's Date (xx/xx/xxxx)

Initials of First and Last Name

Date of Birth (xx/xx/xxxx)

Question Title

* 2. IF you would like to receive information from the Senior Center electronically, please provide your email. OPTIONAL

Enter email.

Please re-enter your email.

Question Title

* 3. Have you taken this survey in the last 6 months?

No or not sure--then please continue with survey

Yes--STOP. Please do NOT continue. Return survey to staff.

Question Title

* 4. What is your gender?

Female

Male

Other

Question Title

* 5. What is your race/ethnicity? Check all that apply.

American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian/Other Pacific Islander

White

Other

Question Title

* 6. What is your age?

54 or below

55 to 59

60-69

70-79

80-89

90 and over

Question Title

* 7. Which Senior Center do you attend most often?

Central Orange in Hillsborough

Seymour Center in Chapel Hill

Question Title

* 8. How did you hear about the Senior Center? Check all that apply.

Brochure

Friend or Family Member

Internet

Newspaper

Senior Times

Other (please specify)

Question Title

* 9. How long have you participated in Center programs?

# of Years

# of Months