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Please check which role best applies to you. COA Staff COA Board Member Public Health Professional Public Safety Professional Library Staff ASAP/AAA Staff Other Aging Services Professional Academic Business Owner Family/Informal Caregiver Professional/Paid Caregiver Community Member Person Living with Dementia Other
of What future
Please choose your own words to categorize yourself.
Which city/town do you represent? Abington Acton Acushnet Adams Agawam Alford Amesbury Amherst Andover Aquinnah Arlington Ashburnham Ashby Ashfield Ashland Athol Attleboro Auburn Avon Ayer Barnstable Barre Becket Bedford Belchertown Bellingham Belmont Berkley Berlin Bernardston Beverly Billerica Blackstone Blandford Bolton Boston Bourne Boxborough Boxford Boylston Braintree Brewster Bridgewater Brimfield Brockton Brookfield Brookline Buckland Burlington Cambridge Canton Carlisle Carver Charlemont Charlton Chatham Chelmsford Chelsea Cheshire Chester Chesterfield Chicopee Chilmark Clarksburg Clinton Cohasset Colrain Concord Conway Cummington Dalton Danvers Dartmouth Dedham Deerfield Dennis Dighton Douglas Dover Dracut Dudley Dunstable Duxbury East Bridgewater East Brookfield East Longmeadow Eastham Easthampton Easton Edgartown Egremont Erving Essex Everett Fairhaven Fall River Falmouth Fitchburg Florida Foxborough Framingham Franklin Freetown Gardner Georgetown Gill Gloucester Goshen Gosnold Grafton Granby Granville Great Barrington Greenfield Groton Groveland Hadley Halifax Hamilton Hampden Hancock Hanover Hanson Hardwick Harvard Harwich Hatfield Haverhill Hawley Heath Hingham Hinsdale Holbrook Holden Holland Holliston Holyoke Hopedale Hopkinton Hubbardston Hudson Hull Huntington Ipswich Kingston Lakeville Lancaster Lanesborough Lawrence Lee Leicester Lenox Leominster Leverett Lexington Leydon Lincoln Littleton Longmeadow Lowell Ludlow Lunenburg Lynn Lynnfield Malden Manchester-by-the-Sea Mansfield Marblehead Marion Marlborough Marshfield Mashpee Mattapoisett Maynard Medfield Medford Medway Melrose Mendon Merrimac Methuen Middleborough Middlefield Middleton Milford Millbury Millis Millville Milton Monson Montague Monterey Montgomery Mount Washington Nahant Nantucket Natick Needham New Ashford New Bedford New Braintree New Marlborough New Salem Newbury Newburyport Newton Norfolk North Adams North Andover North Attleboro North Brookfield North Reading Northampton Northborough Northbridge Northfield Norton Norwell Norwood Oak Bluffs Oakham Orange Orleans Otis Oxford Palmer Paxton Peabody Pelham Pembroke Pepperell Peru Petersham Phillipston Pittsfield Plainfield Plainville Plymouth Plympton Princeton Provincetown Quincy Randolph Raynham Reading Rehoboth Revere Richmond Rochester Rockland Rockport Rowe Rowley Royalston Russell Rutland Salem Salisbury Sandisfield Sandwich Saugus Savoy Scituate Seekonk Sharon Sheffield Shelburne Sherborn Shirley Shrewsbury Shutesbury Somerset Somerville South Hadley Southampton Southborough Southbridge Southwick Spencer Springfield Sterling Stockbridge Stoneham Stoughton Stow Sturbridge Sudbury Sunderland Sutton Swampscott Swansea Taunton Templeton Tewksbury Tisbury Tolland Topsfield Townsend Truro Tyngsborough Tyringham Upton Uxbridge Wakefield Wales Walpole Waltham Ware Wareham Warren Warwick Washington Watertown Wayland Webster Wellesley Wellfleet Wendell Wenham West Boylston West Bridgewater West Brookfield West Newbury West Springfield West Stockbridge West Tisbury Westborough Westfield Westford Westhampton Westminster Weston Westport Westwood Weymouth Whately Whitman Wilbraham Williamsburg Williamstown Wilmington Winchendon Winchester Windsor Winthrop Woburn Worcester Worthington Wrentham Yarmouth
Is your city/town a designated age- and/or dementia-friendly community? Dementia-friendly only Age-friendly only Age-and-dementia-friendly Neither I don't know
Are you interested in learning more about the age-friendly process, which includes guidance for integrating both age- and dementia-friendly activities? Yes No
Are you interested in learning more about the dementia-friendly process, which includes guidance for integrating both age- and dementia-friendly activities? Yes No
Are you interested in learning more about the age- and dementia-friendly process, which includes guidance for integrating both age- and dementia-friendly activities? Yes No
Are you the primary dementia-friendly contact in your community? Yes No
If you know the name and title of the primary dementia-friendly contact please enter it below.
Do you work for or with the current entity that leads your community's dementia-friendly initiative? Yes No
Name of that entity
Do you know if your community has an active dementia-friendly or combined age- and dementia-friendly action team? Yes No It no longer meets
Is there an interest in convening a dementia-friendly action team? Yes No I don't know
Please feel free to share additional improvements, projects, or programming that you have undertaken in your Council on Aging/community to support people living with dementia and their caregivers, including information on multi-sector partnerships or collaboration. (100 word limit)
Would you like to receive the Memory Café Toolkit to learn about how to start and run a Memory Café in your community? Yes No
Are you trained as a Dementia Friend and/or Dementia Champion? Yes No
Would you like more information on how to become a Dementia Friend and/or Dementia Champion? Yes No
Would you like to receive more information on caregiver training and education? Yes No
What are your current dementia-friendly priorities? (100 word limit)
Please feel free to share details about the successes and/or challenges you have experienced in your dementia-friendly work, including any not listed above. (100 word limit)
If applicable, please share some words of wisdom for people who are new to this work. (100 word limit)
How can MCOA best support your dementia-friendly work? (100 word limit)
Are you interested in attending future DFM quarterly meetings and training opportunities? Yes No I'm not sure
What specific topics would be helpful to you? (100 word limit)
Would you be interested in sharing your story about your dementia-friendly work at a future DFM quarterly meeting? Yes No Not applicable
Are you interested in receiving future DFM email notifications? Yes No
Thank you for taking a few moments to complete this survey.