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Educational Program Survey FY09

Page One
1. What county do you live in? Required Question
2. What county do you work in? Required Question
3. What best describes you: Required Question
4. Have you ever attended an Alzheimer's educational program? Required Question
5.
6. Would you need respite services to come to an educational program? Required Question
7. What day(s) of the week are best for you to attend a program? Check all that apply. Required Question
8. What time of day is best for you to attend an educational program? Check all that apply. Required Question
9. What topics would be of assistance or interest to you. Check all that apply. Required Question
10.
11. The Alzheimer's Association socialization programs are for individuals diagnosed with Alzheimer's and their primary caregiver and offers refreshments, a variety of activites, and an opportunity to maintain social contacts in a comfortable, non-judgmental atmosphere. 

Would you be interested in attending a socialization program? Check all that apply. Required Question
12. If yes, what day(s) of the week are best for you to attend a socialization program? Check all that apply. Required Question
13. If yes, what time of day is best for you to attend a socialization program? Check all that apply. Required Question
14.
15. If you would like more information regarding upcoming Alzheimer's educational and/or socialization programs in your area, please complete the information below:











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