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Senior Center Program Interest Survey

  1. Aging Services Logo

  2. 1. What educational topics would you like to explore at your Center? Please check all that apply.

  3. 2. What language classes would you like to take part in at your Center?

  4. 3. What cultural offerings should the Center provide or expand on?

  5. 4. What kind of special or themed events should the Center host?

  6. 6. What kinds of exercise / health promotion classes/programs should the Center offer?

  7. 7. What kinds of additional health screenings should the Center offer?

  8. 8. At what times are you more likely to attend a Center event?

  9. 9. On what days are you more likely to attend a Center event?

  10. 10. Which trips appeal to you?

  11. 11. What domestic destinations would you like to experience through the Center?

  12. 12. What international destinations would you like to experience through the Center?

  13. 14. What elements make up your ideal travel experience?

  14. OPTIONAL - Please check appropriate boxes.

  15. Center you would most often attend:

  16. Gender:

  17. Race/Ethnicity:

  18. THANK YOU FOR YOUR TIME!

  19. Leave This Blank:

  20. This field is not part of the form submission.