Needs Assessment Survey


Needs Assessment Survey

 

1) Please indicate your age range.
2) How do you identify your gender?
3) Please indicate how you identify your race. Select all that apply.
4) Are you of Hispanic or Latino descent?
5) What is your approximate annual household income?
6) How frequently do you have access to healthy, non-processed foods such as fruits, vegetables, dairy products, and whole grains?
7) Where do you typically seek community information for older adults (e.g. caregiver services, home-delivered meals, home repair, medical transport, social activities). Select your top 3.
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8) How important is it for you to remain in your current living situation for as long as possible?
9) Do you need help from someone outside the home to:
10) Do any of the following barriers prevent you from participating in community events? Select all that apply.
11) Are you financially able to cover your expenses for: Select all that apply.
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12) How often do you feel like you need protection from physical, mental, or financial harm:
13) What are your primary modes of transportation for local activities (e.g., shopping, errands, medical appointments, socializing)? Select your top 3.
14) How would you rate Dauphin County as a place for people to live as they age?
15) Are you interested in volunteering with the Dauphin County Area Agency on Aging? If yes, please provide a contact number. To learn more about volunteer opportunities, visit: https://www.aging.pa.gov/Pages/Volunteer.aspx

 

Dauphin County