Senior Ministry


Senior Survey

/files/Images/Senior Ministry/Seniors.gifThe Senior Ministry at RLIC would like for you to take a few moments and respond to our short survey for seniors age 60 and over (men and women).  RLIC cares about our seniors, and is committed to providing you with services that are of importance to you!

Even though, you are 60 and above and may not need some of these services please complete, and check      do not need senior service.  Please write any additional comments or ideas in the space provided.

If you are a senior caregiver, you may complete this survey also.
Please provide us with the following information:

Date:             Email:
                          (mm-dd-yyyy)                      (For no email enter none)
                  
Name:           Age:       Phone:

Address:       City:      State: Maryland  Zip: 

Do not need services below.

Transportation (to church, shopping, appointments, special events)

Run Errands (groceries, post office, pick up medications, etc...)

Light Housekeeping

Senior Wellness ( Meal/ Exercise Planning, Health Seminars)

Senior Excursions (Saturday day trips)

Senior Respite (Relief time for senior care-giver)

Senior Resource Services

Meal Preparation Assistance

Senior Care (Gender appropriate companionship visits)

Food/ or Clothing

Comments/ Suggestions

Thank you for your response!

This information will help us decide what services are of immediate
need for some of our seniors.
Ministry Team Leader:  Sister Lula Roy
  E-mail Address:  roylula@msn.com  Phone #:  443-415-8356
Confidential:  The Senior Ministry and its leadership will not disclose the information provided in this survey, including email information or email contents to any third parties.
        

Enter the numbers as they
are shown in the image above

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