Kūpuna Needs Assessment for Community Members
Thank you for your consideration in completing the survey. We are a group of students pursuing Bachelor and Master degrees in Social Work at the University of Hawaii at Manoa. We are supporting Atherton YMCA programs and services and are interested in exploring how COVID-19 has impacted Kūpuna.

This survey is completely anonymous. No personal information collected in this survey will allow us to identify any survey participant. This survey is optional and while there are no incentives to participate, your survey responses will provide valuable insight and guidance as the Y continues to better meeting the needs of our Kūpuna. Participants may discontinue taking the survey at any time.

If you have any questions, please contact us at studentboard@ymcahonolulu.org.
Sign in to Google to save your progress. Learn more
If you would like information on services available to kūpuna, please reach out to studentboard@ymcahonolulu.org
I understand that this survey is optional and I can stop at any time. *
Age
Gender Identity
Ethnicity
Please describe your relationship to kūpuna (for example: family member, caretaker, administrator at a rehabilitation center, CNA, etc.).
Do you share your home with kūpuna?
Clear selection
In your opinion as caregiver or provider regarding PHYSICAL ACTIVITY and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
In your opinion as caregiver or provider regarding ACCESS TO RENTAL ASSISTANCE AND TRANSPORTATION and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
In your opinion as caregiver or provider regarding ACCESS TO FOOD ASSISTANCE and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
In your opinion as caregiver or provider regarding COMPUTER AND TECHNOLOGY TRAINING and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
In your opinion as caregiver or provider regarding SOCIAL & NETWORKING OPPORTUNITIES and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
In your opinion as caregiver or provider regarding VOLUNTEER OPPORTUNITIES and kūpuna during the COVID-19 pandemic, please respond to the statements below.
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
Services are readily available to kūpuna.
Information is easily accessible to kūpuna.
A variety of activities are offered to kūpuna.
Activities available currently are appealing to kūpuna.
Activities are culturally informed and relevant to kūpuna.
Clear selection
What programs or activities would be most helpful that are not currently available to kūpuna?
What do you believe influences kūpuna’s decision and/or ability to participate in programs and/or activities?
Please provide any additional comments and insight that you think would be helpful.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Hawaii. Report Abuse
Google Forms