This information will be used to profile your region
as a retirement destination.
1. Region and Geography
What is the name of your region?
Example: Boston, Francisco Bay Area, Mt Washington Valley, etc.
What is your state?
-- Please Select --
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
What are the zip code(s) that make up your region?
(5 digit format, comma separated if more than one)
What describes your community type?
(Choose all that apply)
Urban / City
[?]
Suburban / Large Community
[?]
Commuter Town
[?]
Rural
[?]
College Town
[?]
Coastal community
[?]
Nearby military base
[?]
Lively downtown business center
[?]
Please describe your region. (Required)
Example
2. What amenities are available in your region?
Public transportation
(Choose all that apply)
Bus
Nearby major airport
Nearby cruise terminal
Rental cars
Subway
Taxi
Train
VA transportation
Please describe the public transportation offered in your region
Example
Things to Do, Recreation & Fitness
(Choose all that apply)
Access To Green Space
Bike Paths
Beach
Boating
Bowling
Casino
Continuing Education
Dining/Nightlife
Exercise Facilities
Fairs & Festivals
Fishing
Golf Course
Hiking
Hunting
Indoor Swim Facilities
Lake
Movie Cinemas
National Park
Outdoor Concerts
Running Paths
Shopping
Skiing
Sporting Events
Tennis
State Park
Walking Paths
Please describe what there is to do in your region
Example
Cultural Activities
(Choose all that apply)
Arts
Ballet
Concerts
Films
Lectures
Library
Live music series
Museums
Symphony
Theater
Please describe the cultural activities in your region
Example
Medical Facilities
Major Hospital
Wellness center
VA Hospital
Please list/describe the medical facilities in your region.
Example
3. What is your climate like?
(We will gather temperature and weather data automatically)
Natural Disaster Areas
Are you in a high risk zone for any of the following natural disasters?
(Choose all that apply)
Earthquakes
Floods
Hurricanes
Tornadoes
Wildfires
Volcanoes
Please describe your seasons and climate
Example
4. What housing options are available in your region
(Choose all that apply)
Adult communities
Affordable Housing
Apartments
Assisted Living
Condos
Gated communities
Group homes
Houses
Nursing homes
Over 50 Communities
Rental units
Residential care facility
RV Parks
State veteran home
Please describe the housing options offered in your region
Example
5. What assistance for seniors are offered in your region?
(Choose all that apply)
Elder-care facilities
Home care
Meals on Wheels
Senior center
Van services for seniors
Visiting nurses
Please describe the assistances offered to seniors
Example
6. Job or Volunteer Opportunities
Please describe the job and volunteer opportunities available to seniors in your region.
Example
7. Additional Information
URL for additional visitor information
URL for additional relocation information
Email address where requests for free visitor guides can be sent
This is the E-Mail Address where our website visitor's contact information will be sent to.
8. Administrative Contact
Your Name
Your Email Address