Services Survey
Please take a few minutes to complete this survey so we can better serve the community with services and programs that would benefit our community members. Your feedback WILL NOT be shared with any other agencies, it is just for our organization and will be kept confidential. For more information, please visit: www.harmonycafeli.org. We are a non-for- profit organization.
Name
First Name
Last Name
Email
*
example@example.com
Age Group
*
21-35
36-50
51-65
66 and up
Town you live in
*
Your idea/s for a class or program
How would like to attend services or events?
*
In person
Zoom (on line)
Or a mix of both
Which programs would you attend in person?
*
Which programs would you attend online?
*
Would you be able to give a donation for services or programs you attended?
*
Yes
No
Sometimes
By sliding scale based upon income
Donation based on what you can afford at the time
Are you in need of services and program because of lack of funds?
*
Yes
No
Not myself but have a friend or family member that is in need.
I am with organization that has clients in need of services/programs
Would you be interested in volunteering?, if Yes in what are your interests?
Please give us your feedback-opinion-suggestions.
Submit
What would you like to see offered from our organization: (Select all that apply)
*
Meal events that offer healthy meals in a social setting with music or activities.
Meal events that offer healthy meals with speakers on health and wellness topics.
A 4 to 6 week wellness program that focus on healthy eating, wellness education and group support.
Talks on eating healthy on a budget with recipes and food tasting offered on a monthly basis.
Meals that offered at a reduced rate, such by suggested donation or based on income on a weekly basis. (not an event, but picking up meals at a location)
Yoga-Chair Yoga-Meditation and other Wellness classes on zoom (online)
Fruits and vegetables that would be given out on a regular basic (must be in need, based on income)
Should be Empty: