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2. Location

   Required

4. What building do you reside? *
   -- Select One --Chicora CommonsCliffsideDeshonGraystone ManorHistoric LafayetteMaple CourtParker HeightsPresidents SquareRolling Road RegencyTerrace
8. Contact Information

   Optional

10. Name
11. Phone
12. Would you like to be contacted about the survey?

    1. YES
    2. NO
16. Survey

    Please answer all questions and provide as much feedback as possible. 

18. Which of the following Resident Initiatives programs do you participate in?

    Check all that apply.

    1. Resident Council
    2. Transportaion (BART)
    3. Food
    4. Senior Tech Class

    1. Committee Member
    2. Vial of Life
    3. Monitor Tag

    1. Wellness Clinic
    2. Service Fair
    3. Fire Marshal
19. If other, please explain:
21. Which of the following Resident Council activities would you like to see in your building?

    Check all that apply.

    1. Movie Night
    2. Crafts
    3. Exercise Class
    4. Bingo

    1. Meals
    2. Game Nights
    3. Socials

    1. Religious Studies
    2. Book Club
    3. Coffee Club
22. If other, please explain:
24. Which of the following presentations would you find interesting?

    Check all that apply.

    1. Senior Safety
    2. Arthritis
    3. Heart Health
    4. Fall Prevention

    1. Finacial Literacy
    2. Transportaion
    3. Diabetes

    1. Dementia/ Memory
    2. Organization
    3. Social Networking
25. If other, please explain:
27. Which of these topics would you be interested in learning about during a Senior Tech Class?

    Check all that apply.

    1. Computer Basics
    2. Tablets
    3. Laptops
    4. WiFi

    1. Email
    2. Social Media
    3. Typing

    1. Internet Radio
    2. Directions
    3. Games
28. If other, please explain:
30. Which of these agencies, organizations, and/ or programs would you like to see at the Annual Service Fairs?

    Check all that apply.

    1. Health Star Home Care, LLC
    2. Area on Aging
    3. Aetna
    4. Transportation/ BART

    1. Highmark Wholecare
    2. American Red Cross
    3. Meals on Wheels

    1. VOICe
    2. Visiting Nurses Asc.
    3. Big Brother/ Sister

    1. Adult Literacy
    2. SNAP
    3. County Assistatnce
32. Please list any other agencies, organizations, and/ or programs that you would like to see at the Annual Service Fairs:
34. Are there any changes you would like to see at your building, or do you have any additional comments?
36. Thank you for taking the time to complete the survey, it is our hope to continue to provide the best service possible.
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

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