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Additional Information
Why Home Modifications
Home Modification and Safety
Financial Resources
Basics of Accessibility
Facts on Elderly Population
Understanding Different Abilities
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E-mail address (optional)

Age 60 - 69
70 - 79
80 - 89
90 and over

Gender Male
Female

Highest Level of
Completed Education
High School Degree
Vocational/Technical School
Two-year College Degree
Four-year College Degree
Master's Degree
Doctoral Degree

Annual Household
Income
less than $10,000
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
$70,000 - $79,999
$80,000 - $89,999
$90,000 - $99,999
$100,000 or more

Current Residence House
Condominium
Apartment
Other

Approximate Square
Footage
of Residence
Less than 500 square feet
500-1000 square feet
1000-1500 square feet
1500-2000 square feet
More than 2000 square feet

Number of people
currently living
at residence
one
two
three
more than three

Please list any
health-related, physical
limitations you have

Source of hearing
or learning about
this website
Family Member
Online web source/link
Group/club association
Advertisement
Friend
Other

Approximate number of
times I have visited
this website

Approximate total amount
of time I have
spent on this website
less than 15 minutes
15 minutes
30 minutes
45 minutes
1 hour
More than 1 hour

Do you plan to revisit
this website in
the future?
Yes
No

As a result of visiting this website, my knowledge of home improvement strategies has increased:
Greatly
 
Somewhat
 
Not at all

I consider the information presented on this website to be:
Very valuable
 
Somewhat valuable
 
Not at all valuable

Please list the type(s) of modifications you plan to make to your home
based on what you have learned from this website

If no home modifications are planned, why?

Please list the positive   aspects of this website

Please list the negative   aspects of this website

No organization, group, club, association, or person(s) will be given access, in whole or in part, to the information you have provided. Every effort will be made to keep the information strictly confidential. The data will be used for the sole purpose of further developing and improving this website. If you have any comments, suggestions, or questions, please e-mail the primary researcher of this evaluation project, Dr. Paul M. Biner of Ball State University at 00pmbiner@bsu.edu. Thank you.