OFLLAH Neighborhood Survey
| Potential
Clients Would you or anyone you know benefit from these or other services? |
|
| ___ | Transportation to appointments or shopping |
| ___ |
Help in running errands, going shopping or on outings |
| ___ | A regular weekly visit or a phone "check-in" |
| ___ | Someone to walk with, or to walk your dog |
| ___ | Light yard work |
| ___ | Occasional Meals |
| ___ | Medical Equipment or Home Health Aids |
| ___ | Other_____________________________________________________ _________________________________________________________ |
| Potential Volunteers | |
| ___ | Could you volunteer two to five hours per month? |
| ___ | Could you provide clerical help for the OFLLAH program? |
| Community Volunteers | |
| ___ | Would you like an OFLLAH representative to speak to your neighbors? |
| ___ | Are you interested in recieving more information about OFLLAH? |
Thank you for your time. Please print and return this questionnarie
to:
P.O. Box 14633, Tucson, Az. 85732-4633
Name________________________________________Phone_________________________
Address____________________________________________________________________