Elevated Elders Community
First off - Welcome and thank you for taking the time to click the link to this questionnaire!  Before we hop in, I would like to share with you the Elevated Elders current Mission Statement, so that you can have an idea of the vision being held.


"At Elevated Elders, our mission is to create a vibrant, purpose-filled community where wisdom, joy, and connection thrive. We celebrate life at every age by sharing our gifts, experiences, and knowledge with one another — and with our younger generations.

Together, we strengthen the relationships between youth and elders, support one another through life’s transitions, and inspire joyful, authentic living. Through community, purpose, and shared wisdom, we embrace the fullness of life and uplift one another to live with love, vitality, and meaning."


I would also like to remove any stigma surrounding the word "Elders", by sharing the energy that this community is holding.

An Elder is someone in the community who has had the blessing of many experiences throughout their lifetime.  They hold a wisdom that can only come by moving through specific experiences.  Elders hold the ability to make life easier and more understandable for others, by sharing their wisdom.  An Elder is not so much defined by their age, but more so by their awareness and knowledge gained by navigating through their personal life journey.  Elder's hold the ability to share different perspectives, as they continue to move through this lifetime.


I would like to thank you in advance for taking the time to fill out this questionnaire and for sharing it with everyone you know, who you think might benefit from this community, as I personally believe that everyone would!

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Elevated Elders Questionnaire
Thank you for taking the time to fill out this questionnaire.  This questionnaire is for anyone in Huron & Perth County, or anyone from outside the area who would drive to a location within Huron & Perth.  It is my hope that through answering these questions we will be able to determine the interests, needs and hopes for the Elevated Elders Community.  Please answer as honestly as possible.
Participant # 1 - First & Last Name *
Participant # 1 - Email Address *
Participant # 1 - Male or Female? *
Participant # 1 - Date of Birth (Month/Day/Year) *
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Participant# 1 - What did/do you do for work? *
Participant # 1 - Are you on any social media platforms? *
Required
Participant # 2 - First & Last Name
Participant # 2 - Email Address
Participant # 2 - Male or Female?
Clear selection
Participant # 2 - Date of Birth (Month/Day/Year)
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DD
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YYYY
Participant# 2 - What did/do you do for work?
Participant # 2 - Are you on any social media platforms?
What is your home address? 
(Please include street address & town)
 *
Phone Number (Please indicate if this is a cell number or landline) *
Is there a driver in your household? *
Are you able to get out and about on your own?  If not, what is your main obstacle in leaving your home?  Do you or your spouse (if applicable) struggle with mobility issues? *
Are you widowed? *
Is your household experiencing any significant financial constraints that may cause you not to be able to participate in the things you enjoy doing, events/gatherings etc.? *
Are you or your spouse (if applicable) navigating dis-ease of any type? If yes, please explain your current challenges. *
What is it that you are most in need of right now, but are afraid to ask for help or perhaps unsure of who to ask.  Regardless of what you feel the obstacles are, please share honestly. (Eg. Companionship, a break from care giving, friendship, help with caregiving, help with outdoor work etc.) *
Participant # 1 - Check all activities that would interest you. *
Required
Participant # 2 - Check all activities that would interest you.
How often would you be interested in attending gatherings/activities (assuming you were interested in the activity/event taking place)? *
What days of the week would work best for you to gather? Please choose all that apply. *
Required
If there is anything else that you would like to add regarding anything mentioned above or something completely unrelated, please do so here.
THANK YOU!!
Thank you so much for taking the time to fill out this questionnaire.  Please know that any personal information that you have shared with me will be kept confidential and will not be shared.  Your input is very much appreciated and needed to make Elevated Elders into the community I am holding space for!

*If you know of anyone else who may be interested in participating in Elevated Elders, please forward them the link to this survey or have them reach out either by phone or email.
Mobile: 519.276.0403             ElevatedElders@gmail.com
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