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Your Age: *

Denomination / Church Affiliation *

State / Territory *

Approximately what percentage of your congregation is age 65 or older? *

Please enter only a number from 0 to 100.

What ministries/activities are you currently doing that support older adults? *

Examples: hearing devices during worship, senior choir, larger print bulletins,

Do you offer any support related to grief and loss? *

Yes
No

What supports do you offer related to grief and loss?

Do you offer any support for people with dementia? *

Yes
No

Do you offer any support for caregivers of people with dementia? *

Yes
No

What supports do you offer for those with dementia and/or their caregivers?

Would it be helpful to have some instruction/material on how to start a Grief Support Group? *

Yes
No

Would it be helpful to have some instruction/material on how to start a Caregiver Support Group? *

Yes
No

What spiritual practices does your congregation provide older adults? *

Examples: meditation, contemplative prayer or study.

What resources would be helpful in providing spiritual practices for older adults? *

Would it be helpful to you to have resources for providing intergenerational opportunities? *

Yes
No

What else would you like to share regarding assistance you would like in providing programming and services for older adults in your congregation and community?

Follow-Up Questions

If we have additional questions, may we follow up with you? *

Yes
No

Your Name

First

Last

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