2. Your opinions, ideas and feedback are very important to us. Please take a few minutes to respond to this questionnaire and return it to the Council on Aging. We want to know what’s important to you ----- it’s one way we measure both our strengths and areas for improvement. Your response will help us reach our goal of being “Here for You”.
4. Please indicate which activities you participate in at the Council on Aging
6. What is the image of the Council on Aging in the Sandwich Community? How could it be improved?
8. Is the staff helpful and courteous at the Council on Aging?
10. Please list activities you would like to see the COA provide.
12. What areas do we need to improve on?
14. What could we do to attract more seniors to the Center and/or reach out to those who might need us but are not currently using our services?
16. Do you use any of the transportation services? Please list ways that the COA can improve transportation services
18. What are the three most important concerns you have for maintaining an independent lifestyle as you age?
20. If the COA offered evening or weekend programs, would you attend?
22. Are you currently a caregiver for a spouse, friend, family member or grandchild? If yes, for whom are you caring? Are there ways we could help you in your caregiver role?
24. What age range are you?

    1. 60 to 70
    2. 70 to 80
    3. 90 to 100
    4. Over 100
26. Do you believe that we need a new senior center?

    1. Yes
    2. No
27. Do you receive the newsletter?

    1. Yes
    2. No
29. Do you use any of our Outreach Programs?

    1. Yes
    2. No
31. Name (Optional)
32. Age*
34. Phone Number
36. Would you like to be contacted to discuss your ideas and suggestions in a focus group at the Center?

    1. Yes
    2. No
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field