Name
*
First Name
Last Name
Age
Email
*
Phone
(optional)
(###)
###
####
What town/township do you live in?
Aberfoil
Batesville
Bells Crossroads
Blues Old Stand
Boothill
Chunnenuggee
Clayton
Comer
Creek Stand
Enon
Fort Davis
Garmon Crossroads
Great Hope
Greens Crossroad
Hatchechubbee
Hawkinsville
Hays Hill
High Ridge
Hurtsboro
Inverness
Lugo
Midway
Mount Andrew
Oak Grove
Perote
Pine Grove
Roba
Rutherford
Scottland
Spring Hill
Smut Eye
Thompson
Three Notch
Union Springs
White Oak
OTHER
I would prefer to answer these questions over the phone rather than write them. Please contact me for an interview.
Check here if you were a student, teacher and/or leader at Merritt Elementary?
What services would you or your family use at Merritt's Health Center?
What other local health services do you want or need? ... Of all your choices, please list your top 3, with #1 being your top choice.
What classes and activities would you like to participate in?
What other classes would you like? ... Of all your choices, please list your top 3, with #1 being your top choice.
Would you like to TEACH? If so, what would be the title of your class(es)?
What recreational features and facilities would you enjoy?
What other recreation opportunities would you like? ... Of all your choices, please list your top 3 with #1 being your top choice.
Following are potential JOBS at Merritt. Check the ones you would like to work and/or be trained for:
Following are potential JOB TRAININGS available through Merritt. Which ones interest you the most?
What other trainings would help you fulfill your dreams? ... Of all your choices, please list your top 2-3 with #1 being your top choice:
Since Midway no longer has a downtown, what businesses would be good to have at Merritt?
Other businesses I'd like to see at Merritt (of all your choices, please list your top 3 with #1 being your top choice):
Dreaming of owning your own business? If so, describe below:
Check here if interested in taking a course on entrepreneurship and business planning:
What additional ideas, dreams and visions for the Merritt Community Complex would you like to share?
I can commit this much time
check how many hours/week:
My Preferred GROUP(s)
Thanks for taking the time to fill out this survey. Your input will help guide Merritt's transformation.
