Community Survey

Tipp Monroe
Community Services

3 E. Main St.
Tipp City, OH 45371
Phone (937) 667-8631
Fax (937) 667-4003
E-mail

Updated: 01/15/07

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Tipp Monroe Community Services is asking for your assistance to help us better serve you. Please complete and submit the following form to us. Please be sure to fill out all fields.

You can also download a copy of this survey as a Microsoft Word .doc or an Adobe Acrobat .PDF which can be returned to the Community Services office, 3 East Main Street, Tipp City, OH 45371.

TIPP MONROE COMMUNITY SERVICES, INC.
COMMUNITY SURVEY

I am a		I am
How many people live in your household
Please list the ages of each person in your household

I prefer classes in the	My best day for class is
I prefer classes during the
Did anyone within your household take a course or otherwise utilize Tipp Monroe Community Services' activities in 2004?		Yes No
If Yes, which class?
Have you used any of Tipp Monroe Community Services programs prior to 2004?		Yes No

How did you become aware of Tipp Monroe Community Services? Please check any or all that apply.

	Newspaper		School Handouts
	Cable Access		Word of Mouth
	Community Connection		Unaware
	Website

Are you aware that Tipp Monroe Community Services provides activities in:
Education (children's drawing, babysitting, dog obidience, cooking classes)	Yes No
Recreation (adult softball, 3^rd - 8^th grade basketball, playgrounds)	Yes No
Special Activities (Halloween parade & party, breakfast with Santa, garden tour)	Yes No
Social Services (mobile meals, eyeglass program, musical instrument loan program)	Yes No

Do you find the programs / classes
Are there any activities that you feel Tipp Monroe Communit Services should offer or become involved in?

Do you or any household member have an interest in becoming involved with Tipp Monroe Community Serves?
As an Instructor?	Yes No
If Yes, what topic?
Sit on the board of TMCS as a Trustee	Yes No
Special events volunteer	Yes No
Volunteer	Yes No
Please list any talents you wish to share:

Would you be interested in being placed on an e-mail service that will update you on upcoming events?
Yes No

E-Mail address:

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