* 1. In which municipality do you live?

* 2. Gender

* 3. You live ...

* 4. Your age group is :

* 5. Do you feel Good at home ?

* 6. Name 3 measures that appear the most important to live a home as long as possible :

* 7. If you or your spouse's health forced you to move, where would you hope to live?

* 8. In your present home, do you feel safe facing the following dangers

  Not secure at all Little Secure enough Very secure
fire
theft
vandalism
fraud
flooding
great heat
great cold
intimidation

* 9. MUTUAL AND INTERGENERATIONAL CONNECTIONS

In the last year have you used or participated at:

  Never 2-3 times/year Every month Every week
Library
Petanque game
Shuffleboard
Arena
Community center
Group outings outside of area
Municipal festivities (Canada Day, Christmas, Festival, etc.)
Internet access center

* 10. In the last year, did you do any volunteering

  Never 2-3 times/year Every month Every week
For other seniors
With young families
With a local organization
With a community organization (Popote, CABBE, etc.)
With members of your family

* 11. During the next year, would you like to volunteer

  Never 2-3 times/year Every month Every week
For other seniors
With young families
With a local organization
With a community organization
With members of your family

* 12. WORK AND RETIREMENT

If you are retired...

If you had the possibility to return to the work force, would you be interested in

  Not at all Maybe A lot
Part time job (less than 20hrs./week)
Full time job
Occasional job (less than 6 months/year)

* 13. If you are still working...

If your job or your actual employer would allow, would you be interested in

  Not at all Maybe A lot
Part time job (less than 20 hrs/week)
Continue to work full time
Occasional job (less than 6 months/year)
Change jobs

* 14. If you are a farmer or if you know some farmer...

Which of the following statements corresponds the best to the current concerns of people in agriculture

* 15. HEALTH


I am well informed on the health care offered in Bedford

* 16. I need to go out of Bedford, but in Brome-Missisquoi to get health care

* 17. I have problems with transport to receive health care

* 18. I am satisfied with the health care offered in Bedford

* 19. I am satisfied with the health care offered in the Brome-Missisquoi territory

* 20. I receive support to take care of a person of my entourage

* 21. If so, I receive this support from

T