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WHAT DO YOU WANT IN A <br />NEW SENIOR CENTER? <br />WE WANT YOUR INPUT! <br />We are planning for Orange County's 21St Century Senior Centers -one in Southern and one in <br />Central Orange. How do you think they should look? What programs and services should <br />they offer? Your input is important and will be helpful in the design of our new senior centers. <br />What are Senior Centers? They are community focal points for services and programs, as <br />well as opportunities for older adults over their life span. They are designed to enhance senior <br />adults' quality of life and well being, and to enhance their longevity and independence. <br />Please rank the suggested senior center services and functions listed according to their importance. <br />In the space below, please share your most important and creative ideas on programs, <br />functions and design of the centers or you may complete this form on the County Website <br />at: www.co.oran~e.nc.us/a i~ng/hottopics/survey.htm <br />Thank you for your input. <br />It will be included in a report this summer to the County Commissioners. <br />Sincerely, <br />The Orange County Dept. on Aging £~ Aging Advisory Board <br />Friends of the Senior Centers-Chapel Hill £~t Central Orange <br />Deposit Your Completed Input Survey by June 30th in the Suggestion Box at the Senior Centers or return to: <br />The Orange County Deparhnent on Aging P.O Box 8181 Hillsborough, N. C. 27278 <br />Programs/ Services: <br />Functions/Design: <br />All information you give is confidential and will be reported only as a group. Check (~) All that apply: <br />1. ~h- age group: 49 and under 70-~y 60-69 ~ <br />- ~.?-79 ~or ~0+-_- <br />2. I~1~° .ender: ?dale ~ Female- -- ~ ~I <br />. '~lv race: White I>la~k _ <br />His anic_ Asian Other <br />4. My living arrangements: Live alone- With someone- Apartment- Home_ Senior <br />Housin _ <br />5. ?~~1v participation level ir1 <br />enter pro rams is: Daily ~tieekly I~~Ionti~l~~ I Yearle None____ <br />6. My senior center <br />participation is generally <br />in: Chapel Hill- Central Orange/ <br />Hillsborough- Northside_ Community <br />Center in <br />Efland_ Community <br />Center in <br />Cedar <br />Grove <br />7. I reside in: Chapel Hill, I-'illshorou~;h ~ Carrboro ?~'Iebane Pural Orailbe_ <br />8. My Zip Code is: <br />If you would like to be more involved in this process or be informed of future meetings, complete the <br />spaces below. <br />Name <br />Address <br />Telephone <br />City Zip <br />(Turn Over) <br />