Somewhat better Neither better nor worse Somewhat worse Much worse 15) In what ways do you your life is different (better or worse) because of participating in the program? 16) To best serve you in the future, what programs or events would you like to see at Midtown Partners? 17) Are there ways the program can improve? If yes, please explain. 18) The following are statements people have made the food in their household. Please tell me how often this statement has been true for your household in the past 30 days. Check only one box per row. Always Often Sometimes Never Don’t know a) We were not able to afford enough food to eat b) We were not able to afford enough of the kinds of food we wanted to eat c) We were not able to afford to eat at all d) We were not able to afford to eat healthier 19) Please write any additional comments or questions below: Name: _____________________________________ Date: ___/___/___ Could you please provide your phone number in case we need to follow up with you on your experience with the program? Phone: _________________ Appendix 14: Sample Home Repair Flyer
Somewhat better Neither better nor worse Somewhat worse Much worse 15) In what ways do you your life is different (better or worse) because of participating in the program? 16) To best serve you in the future, what programs or events would you like to see at Midtown Partners? 17) Are there ways the program can improve? If yes, please explain. 18) The following are statements people have made the food in their household. Please tell me how often this statement has been true for your household in the past 30 days. Check only one box per row. Always Often Sometimes Never Don’t know a) We were not able to afford enough food to eat b) We were not able to afford enough of the kinds of food we wanted to eat c) We were not able to afford to eat at all d) We were not able to afford to eat healthier 19) Please write any additional comments or questions below: Name: _____________________________________ Date: ___/___/___ Could you please provide your phone number in case we need to follow up with you on your experience with the program? Phone: _________________ Appendix 14: Sample Home Repair Flyer
Midtown-Senior-Health-Assessment-and-Step-By-Step-Guide-to-Creating-a-Senior-Meal-Health-and-Wellness-Program-Lowery.docx