Members Survey

* Indicates required field

Name of Organization: *

Which counties does your organization serve? (check all that apply) *

Lapeer Livingston Macomb Monroe Oakland St. Clair Washtenaw Wayne

Please provide totals covering a full 12 month period of time.

How many older/disabled adults does your organization serve (including their caregivers/family)? *

How many OTHER individuals (excluding older adults, caregivers, etc.) does your organization serve? *

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