Citizens' Center
For Your Information
SURVEY OF INTEREST
1. Do you currently participate in Senior Center activities? ___Yes ___No
If you checked yes, what do you do?______________________________________
How often do you take part in Center activities? _____________________________
If you checked no, what prevents you from participating?
___ I�m too busy.
___ I don�t know anyone at the Center.
___ I don�t want to attend alone.
___ Activities are not on a day or at a time that I can participate.
___ I�m not able to participate because of health problems/disabilities.
___ I am a caretaker for a relative or other person.
___ I don�t have transportation to the Center.
___ Other (specify) ____________________________________________________
2. Would you like to participate more if something of interest were available on a
day and time convenient to you and you had transportation? ___ Yes ___ No
3. Are you a member? ___ Yes ___ No; ___ Lifetime (age 80) ___ Pay dues
SECTION 2
1. What general types of activity would be interesting, beneficial, or fun to you?
(Section 3 lists some specific activities for these general types.)
___ Visual Arts/Crafts
___ Performing Arts
___ Recreation
___ Social events
___ Informative/educational programs
___ Physical Fitness / Sports activities
___ Volunteer Service Opportunities
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