Please complete this survey if you are more than 59 years old and live in Wilson. For each question, please give your best answer.

Do you ever go the Wilson County Senior Center?

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Do you ever go the Wilson County Senior Center?

No, I've never been there

I've been there a few times

I go the center regularly

For those who do not visit the Wilson County Senior Center regularly, what are the reasons that you don't visit the Center? (you may check more than one)

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For those who do not visit the Wilson County Senior Center regularly, what are the reasons that you don't visit the Center? (you may check more than one)

I do not know much about it

I do not know where it is

I do not have transportation

I do not know anyone who goes there

I do not think anything there would interest me

I am too busy

Other reasons

For those who visit the Wilson County Senior Center regularly, what are the reasons that you vist the Center? (you may check more than one)

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For those who visit the Wilson County Senior Center regularly, what are the reasons that you vist the Center? (you may check more than one)

To see my friends or not be lonely

For arts or crafts classes

To each lunch

To use fitness equipment or take exercise class

To play cards, bingo or other games

To volunteer and help others

Other reasons

Do you think that you will visit the Wilson County Senior Center in the next month?

Do you think that you will visit the Wilson County Senior Center in the next month?

Yes

Probably so

Maybe/Maybe Not

Probably Not

No

How would you rate the programs and services at the Wilson County Senior Center?

How would you rate the programs and services at the Wilson County Senior Center?

Excellent

Good

Fair

Poor

Unsatisfactory

The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.

The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.

	Very Interested	Might be Interested	Not Interested
Walking Club	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.
Corn Hole	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.
Ballroom Dancing	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.
Wii Tournament	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.	The Wilson County Senior Center is considering adding the following the activities listed below. Please let us know how interested you are in these.

Do you have suggestions for new activities at the Senior Center that you would like to see?

Do you have suggestions for new activities at the Senior Center that you would like to see?

Did you know that you could call the Wilson County Senior Center to get information about services that you or a family member might need, such as home-delivered meals?

Did you know that you could call the Wilson County Senior Center to get information about services that you or a family member might need, such as home-delivered meals?

No, not until I read this question

Yes

Do you have any suggestions to make the Wilson County Senior Center better? If you do not come to the center, is there something the center could do to make you want to come?

Do you have any suggestions to make the Wilson County Senior Center better? If you do not come to the center, is there something the center could do to make you want to come?

This survey may be anonymous. Fill in the information below only if you want to learn more about our programs or apply for services to older adults. If you prefer not to submit your name and contact information, you may also call the Senior Center at (252) 206-4059.

This survey may be anonymous. Fill in the information below only if you want to learn more about our programs or apply for services to older adults. If you prefer not to submit your name and contact information, you may also call the Senior Center at (252) 206-4059.

Please email me the center newsletter and calendar of upcoming events

I would like to come to the center if you can arrange transportation

I would like to talk to Someone about services for myself or a relative

Your Information

Your Information

Full Name

Street Address

Town

Phoneext.

Zip Code

Email

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