Community for a Lifetime Needs Assessment
Region 2 Area Agency on Aging (serving Hillsdale, Jackson, and Lenawee Counties)
The Community of Brooklyn and Region 2 Area Agency on Aging are gathering input from residents in the 49230 zip code. This information will be used by the State of Michigan Aging and Adult Services Agency to proclaim The Village of Brooklyn as “A Community for a Lifetime.” Please help by answering the following questions. If you are in need of assistance to complete this form, please call 1-800-335-7881. Thank you.
What is your Zip Code?
Your answer
Indicate what county you live in.
Resident Status:
What school district do you live in?
Your answer
How many people live in your household?
Your answer
Indicate your age group
IN THE BROOKLYN COMMUNITY:
Do you feel welcome?
Do the faith-based organizations meet your needs?
Do you have access to a grocery store?
What type of business, products, or services are lacking in the community
Your answer
List comments about the community of Brooklyn:
Your answer
ENTERTAINMENT - Is there a need/would you use:
Seating in or near stores
Walking Trails
Community Center
Pool
Parks
Senior Center
What type of Senior Center programming would you attend?
Your answer
What else might you need or want in Brooklyn?
Your answer
List comments about Brooklyn entertainment:
Your answer
HEALTHCARE
Do you have adequate access to healthcare?
Can you afford the cost of healthcare?
Do you have access to necessary medical testing?
Do you have access to dental care?
Can you afford the cost of your dental care?
Do you have access to a pharmacy?
Can you afford the cost of your medications?
If on Medicare, do you have a Part D Policy to help with prescriptions?
If on Medicare, do you have a Supplemental Insurance Policy?
Do you have transportation to Physician appointments?
What hospital and/or doctor do you use?
Your answer
List comments about healthcare in Brooklyn:
Your answer
SAFETY
Do you feel safe in Brooklyn?
Do you feel isolated?
Do you have safe, affordable housing?
Do you need safety modifications in your home?
Do you have smoke detectors in your home?
Generally, can you afford your housing expenses?
Do you know who to call in an emergency?
List comments about Safety in Brooklyn:
Your answer
TRANSPORTATION
Do you have adequate transportation?
Do you own a car?
Do you need public transportation?
Would you use public transportation?
Who do you call if you need transportation?
Your answer
Where do you need to go?
Your answer
List comments about Transportation in Brooklyn:
Your answer
OTHER COMMENTS
Are you aware of the Area Agency on Aging?
What services have you utilized?
Your answer
Did you receive the help you needed?
If you would like someone to contact you regarding concerns or available services, please list you name and phone number or email address:
Your answer
This information is for use by the Region 2 Area Agency on Aging and the Village of Brooklyn only. Information provided will be used to determine needs of residents in the 49230 zip code.
Thank you for your time and participating in our survey.
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