Form Center

2. 
4. 1. What educational topics would you like to explore at your Center? Please check all that apply.

   1. Finance
   2. History
   3. Politics
   4. Science
   5. Cooking/Baking

   1. Fashion
   2. Health & Wellness
   3. Driving
   4. Home Maintenance / Interior Design
   5. Other (see 1a.)
6. 1a. If you selected "Other," please specify below:
8. 2. What language classes would you like to take part in at your Center?

   1. English as a Second Language
   2. Spanish
   3. Mandarin

   1. French
   2. Italian
   3. Other (see 2a.)
10. 2a. If you selected "Other," please specify below:
12. 3. What cultural offerings should the Center provide or expand on?

    1. Music classes
    2. Dance classes
    3. Theatrical performances
    4. Instrumental performances
    5. Vocal performances
    6. Dance performances
    7. Film series
    8. Excursions to off-site performances (ex. ArtsCenter, DPAC, etc.)
    9. Other (see 3a.)
14. 4. What kind of special or themed events should the Center host?

    1. Holiday-themed events
    2. Events to increase cultural awareness and dialogue
    3. Potlucks
    4. Luncheons and/or dinners
    5. Meet-the-author events and readings
    6. One-time arts, crafts, baking workshops
    7. Other (see 4a.)
16. 4a. If you selected "Other," please specify below:
18. 5. Please share any ideas for special or themed events at the Center.
20. 6. What kinds of exercise / health promotion classes/programs should the Center offer?

    1. Events to increase health awareness
    2. Chronic disease education
    3. Mental health awareness
    4. Walking classes/programs
    5. Falls prevention
    6. Healthy cooking classes
    7. Healthy luncheons and/or dinners
    8. Health and/or Well-being meet-the-author events/readings
    9. One-time health education workshops
    10. Other: Specific exercise/health promotion classes or programs (see 6a.)
22. 6a. If you selected "Other," please specify below:
24. 7. What kinds of additional health screenings should the Center offer?

    1. Blood pressure
    2. Blood glucose & cholesterol screenings
    3. Height & weight checks
    4. Mental health screenings (Dementia, Alzheimer's, Mental Illness, etc.)
    5. Other (see 7a.)
26. 7a. If you selected "Other," please specify below:
28. 8. At what times are you more likely to attend a Center event?

    1. Early morning (8:30 – 10 am)
    2. Late morning (10 am - 12 pm)
    3. Early afternoon (1 - 3 pm)

    1. Late afternoon (3 - 5 pm)
    2. Evening (5 - 9 pm)
30. 9. On what days are you more likely to attend a Center event?

    1. Monday
    2. Tuesday
    3. Wednesday

    1. Thursday
    2. Friday
    3. Saturday
32. 10. Which trips appeal to you?

    1. Local day trips (approx. 6 - 7 hours)
    2. Saturday getaways (approx. 9 - 12 hours)
    3. Extended trips (between 3 - 14 days)
34. 11. What domestic destinations would you like to experience through the Center?

    1. The Triangle region
    2. North Carolina
    3. The South
    4. New England

    1. The Midwest
    2. The West
    3. Other (see 11a.)
36. 11a. If you selected "Other," please specify below:
38. 12. What international destinations would you like to experience through the Center?

    1. Asia
    2. Africa
    3. South & Central America

    1. Europe
    2. Middle East
    3. Other (see 12a.)
40. 12a. If you selected "Other," please specify below:
42. 13. Please share any specific cities or sites you would like to visit on a Center trip.
44. 14. What elements make up your ideal travel experience?

    1. Free time to explore
    2. Group excursions
    3. Culinary experiences
    4. Shopping opportunities
    5. Visiting historical sites

    1. Interacting with art or music
    2. Experiencing nature
    3. An urban environment
    4. Other (see 14a.)
46. 14a. If you selected "Other," please specify below:
48. 15. Please tell us about the most memorable event, program, or trip you have experienced!
50. OPTIONAL - Please check appropriate boxes.
52. Center you would most often attend:

    1. Passmore (Hillsborough)
    2. Seymour (Chapel Hill)
53. Gender:

    1. Male
    2. Female
54. Race/Ethnicity:

    1. American Indian/Alaska Native
    2. Asian
    3. Black or African-American
    4. Hispanic/Latino
    5. Native Hawaiian/Pacific Islander
    6. White
    7. Other
56. THANK YOU FOR YOUR TIME!
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