Lehigh Valley Alliance on Aging

Life Fulfillment Questionnaire

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Take the Life Fulfillment Questionnaire

Welcome to the Life Fulfillment Questionnaire. This tool was devised to assist adults in deciding what may be of interest to them in their retirement. The tool is designed to be answered here on this site, but will not be saved once you have used it. If you would like to keep a copy of your answers, please print out a copy.

To take part in the questionnaire, please select a number for each of the boxes next to each comment. The number should indicate how good you feel at this time about each of the areas mentioned. If you are very happy with the comment, please type in or select a 5 for that box. If you are not at all happy about the comment, please type in or select 1. So, for comment number one “The style and condition of my home”, you could type in a 3 if you are not particularly happy with your home, but are not really ready to move; or a 1 if you can hardly wait to get out; or a five if you just couldn’t imagine living anywhere else!

At the end of the questionnaire, you will find a button to push in order to get the scores totaled. Click on the “TOTAL” box and the computer will add your scores and place those scores under the pictures corresponding to the categories the tool uses to score. The categories that have the higher scores are the ones you seem to have more interest in or satisfaction with. The less the score, the less satisfied you may be with that category. You can use this information different ways. For example, you may find that your satisfaction score with Finances is low and that may prompt you to think about learning more about this area to help increase your satisfaction. You may find that your satisfaction with Employment is low, but that’s OK with you!

Under each picture you will find a list of web links that you can click on to find out more information. These are a few of the many opportunities that exist and we hope to update the list frequently.

Questions:	Score:
The style and physical condition of my home
My personal income and financial assets
My mental health and freedom from depression and anxiety
The sense of accomplishment I get from my work
The sexual intimacy I have with another
The connection I feel with God or a Higher Power
The safety of my home and neighborhood
The opportunities I have to attend social or cultural events
The warmth and caring I feel with my immediate family
The amount of quality sleep I get each night
The involvement I have with activities in my community
The mental and social stimulation my work provides me
My independence, the ability to do what I want to do
Opportunities for learning new and interesting things
My level of physical activity and stamina
My involvement with a faith-based congregation
My participation in social clubs and/or civic organizations
My savings for emergencies or future financial needs
Time to pursue hobbies and recreational activities
The support I have from friends and neighbors
My involvement with service and volunteer activities
Easy access to places and events in the local area
The healthfulness of my daily habits and activities
I have opportunities for privacy in the place I live
I understand and actively manage my finances
"Play money," i.e. discretionary funds to buy gifts, travel
The time I set aside for prayer, meditation, or contemplation
People in my life I can trust and be open with
Access to quality health care when I need it
The comfort and enjoyment I feel in my city, town, locale
Confidence I feel in my financial security
The hours and conditions of the work I do
My overall health and freedom from disabling conditions
Opportunities I have to socialize with people I enjoy
Outlets for my creative pursuits and interests
Understanding myself, my accomplishments and my goals
Having a positive outlook on life and my future
My willingness and ability to help out a neighbor or friend in need
My work provides me opportunities to feel useful and purposeful
Staying current on news events and other happenings in the world
The time I have for rest and relaxation on a daily or weekly basis
My work enables me to apply my talents, experience, and/or education
I contribute my time and resources to promote a cause I believe in.
My ability to travel for personal leisure and/or interest
My memory and mental alertness are intact

Personal & Spiritual Growth

Mental Vitality

Recreation

Meaningful Service

If you found this questionnaire interesting, you will want to know that it is a part of a larger class taught by agencies in Easton, Bethlehem and Allentown. The classes are taught in various sites throughout those cities in a regular basis. The classes are taught by a group of volunteers and are supported by a group of peer coaches who are available to assist you in the classes. For more information, please contact one of the following:

Joan Schaffer
Third Street Alliance for Women & Children
41 North Third Street
Easton, PA 18042
610.258.6271
jschafer@thirdstreetalliance.org
www.thirdstreetalliance.org

JoAnn Frey
Bethlehem Senior Centers
720 Old York Road
Bethlehem, PA 18018
bethsrs@ptd.net

Rick Daugherty
Lehigh County Senior Center
1633 Elm Street
Allentown, PA 18102
rick@lehighseniors.org

Lois Fuini
Allentown YMCA & YWCA
425 South 15^th Street
Allentown, PA 18102

Modified with permission from Senior Resource Alliance.

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