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Please list your name, title and organization.
   
 
 
 
Does your organization/site offer evidence based fitness programming for older adults?
 
Yes
 
No
 
Not Sure
 
 
 
If you answered yes to question 3, what is the name of the program that you are offering?
   
 
 
 
Do you offer any of the following (please indicate all that apply).
 
Matter of Balance
 
Spring Chickens
 
Healthy Steps
 
Better Bones and Balance
 
Active Start
 
Other
 

 
 
 
If the program was cost effective and sustainable, would you consider offering any of the following programs. Please indicate all that apply.
 
Matter of Balance
 
Spring Chickens
 
Healthy Steps
 
Better Bones and Balance
 
Active Start
 
Would not be interested in offering any of the above
 
Other
 

 
 
 
If you are not interested in offering any of the programs from the list above, please indicate why.
   
 
 
 
Before taking this survey, where there any programs in which you were not familiar? If so please indicate which ones. Select all that apply.
 
Matter of Balance
 
Spring Chickens
 
Silver Sneakers
 
Better Bones and Balance
 
Active Start

 
 
 
Please indicate any programs that you may be interested in offering at your location.
 
Balance
 
Strength
 
Endurance
 
General Health
 
Disease Management
 
Other
 

 
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