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2018 Senior Center Participant Survey

  1. Parks Logo

  2. 2018 Senior Center Participant Survey

    Please help us evaluate our program by filling out this ANONYMOUS survey.

  3. 1. Please identify the senior centers that you attend.*

    (Check all that apply)

  4. 2. How long have you been coming to the senior center?

  5. DEMOGRAPHIC INFORMATION

  6. 3. What is your age range?

  7. 4. What is your gender?

  8. 5. What is your annual income?

  9. 6. Has your participation in the senior center made a difference in your life in any of the following ways?

    (Check all that apply)

  10. 7. Do you encourage others to come to the senior center?

  11. 8. What are the primary reasons you attend the senior center?

    (Check all that apply)

  12. 9. Which statement best describes your experience with the senior center?

  13. DO YOU FEEL:

  14. 10. Staff is courteous and helpful?

  15. 11. Staff is knowledgeable and professional?

  16. 12. Volunteers are courteous and helpful?

  17. 13. Why do you come to lunch at the senior center?

  18. 14. If you do not come to lunch, why not?

  19. 15. Are the outside grounds, walkways and stairs in good condition?

  20. 16. Are the floors in good condition without tripping hazards?

  21. 17. Is the center lighting adequate?

  22. 18. Is the facility clean?

  23. 19. Are the restroom facilities clean and sanitary?

  24. 20. Do you have any building safety concerns?

  25. Leave This Blank:

  26. This field is not part of the form submission.