FALL 1993
A. Hello. My name is _________________. I am a student at Illinois State University. Our Field Geography class is conducting interviews for your local area agency on aging, seeking information from citizens sixty years of age or older about senior meal programs. (Decide whether resident is near or over sixty. If YES, ask . . .)
B. Are you sixty or more?
YES _____
NO _____
If YES, go to #C. If NO, go to #D.
C. Do you live here?
YES _____
NO _____
D. May I please speak to a resident who is sixty or more?
YES _____ NO _____
(If NO, offer brochure, thank, and leave.)
(If YES, ask to see sixty-plus resident, introduce self and project.)
(To the original resident who was sixty-plus or to referred resident say . . .)
E. Would you mind volunteering a few minutes to answer some questions about senior meal programs? I will keep your answers confidential, we will report results in a grouped fashion, and your participation is voluntary.
YES _____
NO _____
(If YES, complete #1 and go to #2. If NO, offer brochure, thank, and leave.)
1.
Background: C B Tract
# _______ Address ______________________________
M F
A-A A-P HIS N-A W
What is your
age? ______________
2. Are you aware of any senior meal programs in your area?
YES NO If
NO, go to #3. If YES, go to #4a.
3. Would you like more information about the Peace Meal senior meal program?
YES NO
If YES, offer brochure, thank, and leave.
If
NO, thank and leave.
4a. Have you ever participated in the Peace Meal senior meal program in your area?
YES NO
If YES, go to #4B. If NO, ask why, offer brochure, thank,
and leave.
Why not? What would
bring you to Peace Meal?
4b. Which type of service did you receive?
Community location
_______ Home-delivered
__________ Both ______
If only
"home-delivered ," ask for comments, thank, and leave.
If "community location" or "both" go to #5a.
5a. How often do you now participate in community location Peace Meal?
1. No longer participate _____
2. Less than once a month _____
3. Once a month _____
4. Once every week or so _____
5. Almost every day _____
If they no longer participate, go to #11.
5b. How did you learn about Peace Meal?
6. Which Peace Meal sites do you attend?
Western Ave. _____
Miller Park
_____ Chenoa
______
Woodhill
_____ Normal
______
Other
_____________________
7. As a participant in Peace Meal, what do you like most about Peace Meal?
8. What do you like least about Peace Meal?
9a. Do you know the suggested donation for each Peace Meal?
YES NO If
YES, go to #9b. If NO, go to #9c.
9b. How much is that suggested donation? $_____________
9c. The suggested donation is $1.50 per meal.
10. How do you get to the Peace Meal sites?
City bus _____
Drive
_____ Walk
_________
Senior van
_____ Car-pool
_____ Other
___________________
Skip #11 and #12. Go to #13.
11. Why did you stop participating in Peace Meal?
12. What would bring you back to Peace Meal?
13. Which of these describes the Peace Meal program?
Low-cost meal
_____ Handout
_____ Government
program _____
Place to socialize
_____ Charity
_____ Welfare
program _____
Nutritious food
_____ Place
to receive senior services information _____
14. Do you have any other comments you would like me to relay to the Peace Meal staff?
Thank. Offer brochure. Depart.
Contact me via email at mdsuble@ilstu.edu
Return to Previous Questionnaire List.
Learn more about me at my homepage.
Created 11 August 1998. Last revision occurred 11 August 1998.