AGE-FRIENDLY BARRINGTON SURVEY LET YOUR VOICE BE HEARD!
Email address *
Check All Activities You Participate In
Check Any Programs You Are NOT AWARE of
Do You Need Assistance With Technology (computer, TV Remote, DVD, streaming, etc.)?
Very Skilled. No Problems.
Cannot Use Without Help.
Do you Want To Remain in Barrington As You Age?
What Would Improve Your Quality of Life As You Age?
Your answer
Would You Favor the Creation of A Volunteer Network of Support in Town?
If A Volunteer Network of Support Were Created in Barrington, Would You Want To: (check all that apply)
Age
How Many Years Have You Lived in Barrington?
Do You Own or Rent Your Home?
Number in Household
Your answer
Name-Your Contact Information will allow us to invite you to hear the results.
Your answer
How Difficult Is It For You To:
A. Participate in Social Activities and Relationships
No Problem
Extremely Difficult
B. Maintain Your Residence
No Problem
Extremely Diifficult
Reason(s), if Any
C. Feel Safe
No Problem
Extremely Difficult
Reasons (if Any)
D. Get Where You Want To Go
No Problem
Extremely Difficult
What Places?
Comments:
Your answer
Completed Surveys can be dropped off at Barrington Town Hall, the Library, or the Peck Center for Adult Enrichment
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