Community Needs Assessment Survey
RequiredRequired Question(s)
Required 1.
Are you a resident of Pleasant Hill?
Yes
No
Required 2.
Are you age 55 or over?
Yes
No
Required 3.
Do you care for someone age 55+ who lives in Pleasant Hill?
Yes
No
4.
What is Pleasant Hill doing well to address to issues of purposeful aging in our community?
 

1000 characters left.
5.
What should we be doing to enhance the quality of life for older residents of Pleasant Hill?
 

1000 characters left.
6.
What are your ideas for workshops or seminars that we could offer at low or no cost addressing purposeful aging in Pleasant Hill?
 

1000 characters left.
7.
In the event of an emergency or disaster (such as a major earthquake), are you prepared or do you have an emergency plan in place? If so, please provide details of what that might be.
Yes
No
  • Comment:

  • 500 characters left.
8.

 

Other comments:
 

350 characters left.
9.
Your Contact Information (Optional):

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
City:

10.
We can always use help to put on a free event.
Would you be interested in volunteering at one of our events?
Yes
No
N/A
  • Comment:

  • 500 characters left.
Thank you for your input.  It is very much appreciated.