Please Fill Out Our
COMMUNITY SURVEY
So we can better serve you as a Jaycees Chapter. Thanks!
Please give us your opinion on what kind of need exists in Rochester
for programs in the following areas:
(KEY: 1=heavy need, 2=some need, 3=little need, 4=no need)
Food Assistance:
1
2
3
4
Shelter for Homeless:
1
2
3
4
Environmental Problems:
1
2
3
4
Recycling Services:
1
2
3
4
Elderly Assistance:
1
2
3
4
Youth Service Clubs:
1
2
3
4
Recreation for Children:
1
2
3
4
Recreation for Teens:
1
2
3
4
Recreation for Elderly:
1
2
3
4
Cultural Awareness:
1
2
3
4
Community Clean-Ups:
1
2
3
4
Summer Programs:
1
2
3
4
Fall Programs:
1
2
3
4
Winter Programs:
1
2
3
4
Spring Programs:
1
2
3
4
Governmental Awareness:
1
2
3
4
Local Charities:
1
2
3
4
National Charities:
1
2
3
4
Civil Rights:
1
2
3
4
Alcohol/Substance Abuse:
1
2
3
4
Physical/Sexual Abuse:
1
2
3
4
Your Name:
Street Address or PO Box:
City/State (if not NH):
Zip Code:
Phone:
Would you like more info on the Jaycees?
Yes
No
Age Range:
Under 18
18-20
21-39
40-65
Over 65
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