Aging in Community Survey

The "Aging in Community" working group consists of neighbors volunteering to assist neighbors in maintaining their independence, thereby increasing a sense of Civano spirit. Initially the group will be attempting to provide a variety of services to the mature residents of Civano; i.e. transportation, home visits, occasional meal preparation, etc., but with the availability of volunteers and the need in the Community, the program can be expanded.

Civano Neighborhood Association is developing this new FREE service!
Neighbors—Do you need a little help with…? (We would appreciate your input and answers to this survey. We need input from all Civano residents, please help us).

Enter your responses below:

Fields marked with * are required.

Name	*
Street Address
Telephone	*
E-mail	*
Do your children live with you?   No  Yes
Age and # of Family Members	Age # of Family Members 0-10 11-21 21-30 31-40 41-50 51-60 61-70 71+
Please select (check) services that you and your Civano-based family might need at some time.
General transportation (groceries, pharmacies) Transportation to doctors or therapy during treatment Weekly phone calls or friendly visits Help with letter writing or forms Occasional meal preparation (in-house) Emergency meal delivery Cargiver relief/person sitting Household chores/light housekeeping Minor house repairs (light bulbs, etc.) Yard work Limited dog walking Referral information for Pima/Tucson Social Services Help with organizing bills, checkbook, mail, or tax preparation Use of medical alert system Other:
Do you know of a neighbor who may need help? If so, please complete:
Neighbor Name
Street Address
Comments
We need volunteers. Would you be willing to help in one or more of the above areas? If so, please complete:
Area
Area
	Form may process slowly: please click 'Submit' only once.   View privacy information.

For further information, please contact Bob Small at 520.398.7100.
 

  Site Map  |  Disclaimer  |  Privacy

CivanoNeighbors.com, the Civano Neighbors Neighborhood Association Website
Copyright © 2006 Civano Neighbors. All rights reserved.