1. How would you rate your community as a place for people to live as they age?

    2. What is the name of your community?

    3. What is your 5-digit ZIP code?

    4. How age accomodating (senior friendly) is the housing in your community?

    5. How would you rate the outdoor spaces in your community/municipality?

    6. How age friendly is public transit in your community/municipality?

    7. How often do you engage in some form of physical exercise for 30 minutes?

    8. How frequently do you interact with your friends, family or neighbors in your community?

    9. Where have you gone for continuing education, community education or self-improvement classes/workshops within the last 5 years?

    10. How often do you engage in some form of volunteering ?

    11. Where do you typically go for volunteer activities in your community?


      12. Which of the following best describes your current “paid” employment status?

      13. Will you continue to work past the average age of retirement? Will you be re-employed after retiring from a career?


        14. How often do you search for information about services in your community such as...

        15. Would you turn to the following resources if you, a family member or friend needed information about services for older adults,

        ABOUT YOU

          16. Are you male or female?

          17. What is your age as of your last birthday?

          18. What is your marital status?

          19. Besides you, do you have any of the following people living in your household?

          20. Does any disability, handicap, or chronic disease keep you and your spouse or partner from participating fully

          21. What is your race?

          22. Is English your first language?

          23. While at home how often do you speak English?

          24. What is the highest level of education you have completed?

          25. Please use the space below for any additional comments.

          • Thank you very much for completing this survey.

            Your assistance in providing this information is greatly appreciated.