4. 
5. Senior Center Participant Survey

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

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

   (Check all that apply)

   1. Bellingham
   2. Blaine

   1. Everson
   2. Ferndale

   1. Lynden
   2. Pt. Roberts

   1. Sumas
   2. Welcome
9. 2. How long have you been coming to the senior center?

   1. Less than 1 year
   2. 1-3 years

   1. 3-5 years

   1. 5-10 years

   1. Over 10 years
13. DEMOGRAPHIC INFORMATION
15. 3. What is your age range?

    1. Less than 60
    2. 60 - 69
    3. 70 - 79
    4. 80 - 90
    5. Over 90
16. 4. What is your gender?

    1. Female
    2. Male
17. 5. What is your annual income?

    1. Less than $15,000
    2. $15,001 - $25,000
    3. $25,001 - $50,000
    4. $50,001 - $75,000
    5. Over $75,000
21. 6. Has your participation in the senior center made a difference in your life in any of the following ways?

    (Check all that apply)

    1. I have tried new activities
    2. I have received useful information
    3. I feel more healthy and fit
    4. I have made new friends

    1. I have learned new skills
    2. I am getting out more often
    3. I enjoy life more
    4. I feel that others have shown an interest in my well-being
23. 6a. Comments
25. 7. Do you encourage others to come to the senior center?

    1. Yes

    1. No
27. 7a. Comments
29. 8. What are the primary reasons you attend the senior center?

    (Check all that apply)

    1. Meal Program
    2. Educational Programs
    3. Trips and Tours
    4. Computer Classes
    5. Card Games and Pool
    6. Volunteer Opportunities
    7. Craft Activities
    8. Center Music & Dance Groups

    1. Exercise Classes
    2. Weekly Dances
    3. Strength Training Program
    4. Social Reasons
    5. Health Programs and Clinics
    6. Guest Speakers
    7. Entertainment Program Performances
    8. Support Groups
31. 8a. Comments
33. 9. Which statement best describes your experience with the senior center?

    1. Very satisfied
    2. Satisfied

    1. Somewhat satisfied
    2. Somewhat dissatisfied

    1. Very dissatisfied
35. 9a. Comments
39. DO YOU FEEL:
41. 10. Staff is courteous and helpful?

    1. Yes
    2. No
42. 11. Staff is knowledgeable and professional?

    1. Yes
    2. No
43. 12. Volunteers are courteous and helpful?

    1. Yes
    2. No
45. 12b. Comments
49. 13. Why do you come to lunch at the senior center?

    1. It is my main meal of the day
    2. The food is tasty and well-prepared
    3. It is hard for me to prepare meals at home

    1. The meal is affordable
    2. I come to eat with friends
51. 14. If you do not come to lunch, why not?

    1. Menu not to my liking
    2. Quality of food
    3. Atmosphere

    1. Cost
    2. Other
53. 14a. Comments
57. 15. Are the outside grounds, walkways and stairs in good condition?

    1. Yes
    2. No
59. 16. Are the floors in good condition without tripping hazards?

    1. Yes
    2. No
61. 17. Is the center lighting adequate?

    1. Yes
    2. No
63. 18. Is the facility clean?

    1. Yes
    2. No
65. 19. Are the restroom facilities clean and sanitary?

    1. Yes
    2. No
67. 20. Do you have any building safety concerns?

    1. Yes
    2. No
69. 20a. Comments
73. Please tell us more about your experience at the senior center?
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field