Hadassah Harvest - Food Sub Committee Senior Support Services
Hadassah Harvest participates with Gwinnett Cares Food Sub-Committee, we would like to do some initial research on services provided (or not provided!) to Gwinnett County residents staying in our local extended stay motels. We have created this brief survey to help capture information on how we may best serve the seniors in our community. Thank you for your time and participation.
Date
MM
/
DD
/
YYYY
Name (First and Last)
ADDRESS: (If you live in an Extended Stay Motel please include the name of the motel and address).
Room # (Extended Stay residents)
How long have you resided at this location?
Telephone or Cell Phone Number
Email Address
Age
Clear selection
It is easy for me to meet monthly expenses
Clear selection
Are you comfortable using a computer?
Clear selection
What type of transportation do you use most often? Please check only one answer.
Clear selection
What services would be, or would have been, the greatest help for you?
Would you prefer prepared cooked meals or boxed food items delivered to you as an option?
Clear selection
Do you have any meal dietary requirements or restrictions?
Clear selection
Specialty Diets?
Clear selection
Do you have any strength and hand flexibility limitations that would encumber hardship to open or handle cans?
Clear selection
What are the most important issues facing seniors?
Notes
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