Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Meal Site Survey

  1. How long have you been attending the Agawam Senior Center for lunch?*
  2. What is your age?*
  3. In what town do you currently live?*
  4. How many days per week do you typically attend the Agawam Senior Center?*
  5. How many days a week do you typically eat lunch at the center?*
  6. How many days a week does your primary meal come from the center?*
  7. Please rate the overall quality of the meals:*
  8. The hot meals are always served hot.*
    Please rate the how often this statement is true.
  9. The Cold meals are always served cold*
  10. The staff are courteous and efficient.*
  11. The time of service is appropriate and consistent.*
  12. The meals served by the Agawam Senior Center meet my nutritional needs.*
  13. The dining room is always clean*
  14. How many servings of fruit do you usually eat?*
    One serving of fruit is one piece of fruit; one half cup chopped, cooked, or canned fruit; or 3/4 cup of juice.
  15. What would encourage you to attend the Agawam Senior Center more often?*
  16. Overall, how would you describe your experience with the staff at the Agawam Senior Center?*
  17. How likely are you to recommend our meals to a friend or family?
  18. Are you aware that the meals provided are free of charge and that we suggest a $3 donation?*
    This donation helps to ensure the continuation of the program for future seniors
  19. Ia m satisfied with the variation of the meals offered on a weekly basis.*
  20. I am satisfied with the taste of the meals.*
  21. I enjoy the presentation of the meals.*
  22. Please leave any additional comments you may have for us.
  23. Follow up from Staff
    If you would like a staff person to follow up with you to clarify any questions you may have, or to give further feedback please leave your name and number below.
  24. Leave This Blank:

  25. This field is not part of the form submission.