Survey

**PLEASE PRINT AND RETURN TO THE CENTER **

Liesure Interest and Program Survey

Ruth P. Carter Center • 200 East Franklin Street • Gallatin, Tn 37066

615-451-1531

WE ARE REQUIRED BY OUR FUNDING AGENCIES TO SURVEY THE SENIORS IN OUR AREA TO DETIRMINE THEIR NEEDS, DESIRES AND PROGRAMMING INTERESTS. THE RESULTS OF THIS SURVEY WILL BE USED IN OUR YEARLY CALENDAR PLANNING. YOUR RESPONCE IS VERY MUCH NEEDED.

PLEASE FILL OUT THIS SURVEY AND RETURN IT TO THIS CENTER OFFICE THIS MONTH. THANK YOU SO MUCH.

PLEASE LIST 6 ACTIVITIES THAT YOU ENJOY:

1. ____________________________ 2. ____________________________

3. ____________________________ 4.____________________________

5.____________________________ 6.____________________________

WHAT ACTIVITIES WOULD YOU LIKE TO TRY THAT YOU HAVE NOT TRIED BEFORE.?

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WHAT PROGRAMS WOULD YOU LIKE TO HAVE AT THE CENTER??? BE SPECIFIC AS POSSIBLE!!

1. HEALTH RELATED PROGRAMS_______________________________________________

2. ENTERTAINMENT PROGRAMS_______________________________________________

3.CRAFT PROGRAMS__________________________________________________________

4. EDUCATIONAL PROGRAMS__________________________________________________

5. RELIGIOUS PROGRAMS______________________________________________________

6. SELF IMPROVEMENT PROGRAMS_____________________________________________

7. POLITICAL PROGRAMS______________________________________________________

8. OTHER_____________________________________________________________________

WHAT DO YOU THINK THE SENIOR CENTER SHOULD BE DOING IN OUR COMMUNITY TO MAKE LIFE BETTER FOR PEOPLE OVER 60 YEARS OF AGE???

_______ MORE RECREATIONAL EVENTS, PICNICS, PARTIES AND TRIPS

_______ MORE EDUCATIONAL PROGRAMS, I.E. CURRENT EVENTS, MEDICARE

_______ MORE FREE HEALTH SCREENINGS AND HEALTH PROGRAMS

_______ MORE SERVICES PROVIDED

_______ MORE LOW COST DAY TRIPS

A. TELEPHONE REASSURANCE

B. SUPPORT GROUP - CANCER, BEREAVEMENT, ALZHEIMER'S, DIVORCE, GRANDPARENTING, PARKINSON'S DISEASE AND OTHERS.

ANY SUGGESTIONS FOR MAKING OUR CENTER BETTER ABLE TO SERVE OUR COMMUNITY BETTER IS NEEDED

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