Gratitude Story Questions
RequiredRequired Question(s)
NJV has developed some questions that might remind you of a situation or opportunity that triggers a GRATITUDE STORY about how older adult individuals and communities have been impacted and their family and neighbors have reached out. Your responses (and those of others who will respond) will also help NJV plan future programs with you and negotiate for new or expanded services.
 
 
Required 1.
How has your quality of life changed since December 2019?
Better
Worse
Unchanged
  • Comment:

  • 500 characters left.
Required 2.

What needs or limitations/challenges did you have prior to COVID-19?

Driving
Mobility
Shopping/Errands
Preparing Meals
Use of Technology
Home maintenance
Personal Care
Bills, Insurance or other paperwork
Safety and Security
None
Other  
  • Comment:

  • 500 characters left.
Required 3.

What new needs or limitations/challenges do you have as a result of COVID-19? 

Quarantine due to age making me more vulnerable to COVID-19
Quarantine due to health issue(s) making me more vulnerable to COVID-19
Shopping/Errands
Preparing Meals
Use of Technology
Home maintenance
Personal Care
Bills, Insurance or other paperwork
Safety and Security
None
Other  
  • Comment:

  • 500 characters left.
Required 4.
WHO has become more aware of and responsive to your possible needs or limitations/challenges during the COVID-19 quarantine?
Family member
Neighbor
Friend
Doctor
Church or temple
Senior Center or organization
Municipal or County Service
Not-for-profit organization
For-profit-business
Other  
  • Comment:

  • 500 characters left.
Required 5.
HOW were your needs or limitations/challenges communicated to them or how did they reach out to see if you needed help?
Phone call or email or on-line form to request help
Phone call or email to check-in on family member
Phone call or email to check-in on friend
Phone call or email to check-in on neighbor/acquaintance
Phone call or email to check-in by church, temple, senior organization
Phone call to medical provider
Phone call or email made to rekindle old relationship
Outreach call, email or postcard from municipality or local organization
Marketing call, email or postcard from local service provider
Over internet meeting or support group (Zoom, Google or other)
Other  
  • Comment:

  • 500 characters left.
Required 6.
WHAT HELP, if any, was/is being provided for you?
 

350 characters left.
Required 7.
How have you become more aware of others' needs or limitations/challenges and/or volunteer opportunities during COVID-19?
Phone call or email
Newspaper
Internet
Social media
Meetings over internet
Via family member, friend or neighbor
NJV website
Website or communications from organizations or faith communities
Communications from municipality or county
Other  
  • Comment:

  • 500 characters left.
Required 8.
What help, if any, have you been able to provide for other older adults or other members or your family or community?
 

350 characters left.
Required 9.
Are there old contacts or relationships that have been renewed during the COVID-19 quarantine?
Yes
No
  • Comment:

  • 500 characters left.
Required 10.
Are there new contacts or relationships that have developed during the COVID-19 quarantine that you would like to maintain?
Yes
No
  • Comment:

  • 500 characters left.
Required 11.

Enter your GRATITUDE STORY. Limit own identity and that of others to first name/title of professional/type of entity and your and their town in your story. (i.e. A  pharmacist in Paramus was extremely helpful to me when my pharmacy could not fill my prescription.  I do not use credit cards and he went above and beyond by making phone calls and arranging means of payment and delivery. Sue, Westwood, NJ)



 

1000 characters left.
12.
If you would like to use more specific identity information in your Gratitude Story, please contact NJV (Kathy@northjerseyvillages.org) or provide your contact information below so that we can contact you.

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:
State/Province
(US/Canada):
Postal Code:

Please click Finish to submit your response.

THANK YOU!