Texas Congregate 

Meal Initiative

Appendix Documents
Table of Contents

Appendix Documents.............................................................................................................................................................................. 1

Appendix A – TCMI Learning Collaborative Application.............................................................................................. 3

Appendix B – Simple Logic Model Template ........................................................................................................................ 4

Appendix C – TCMI Innovative Pilot RFP ................................................................................................................................... 5

Appendix D – Dashboard Examples............................................................................................................................................ 6

Appendix E – TCMI Program Manager Survey..................................................................................................................... 7

Appendix F – TCMI Client Survey.................................................................................................................................................... 8
Appendix A – TCMI Learning Collaborative Application
TCMI Learning Collaborative Application

Disclaimer: This project was supported, in part by grant number 90INNU0013, from the 

Administration for Community Living, U.S. Department of Health and Human Services, 

Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are 

encouraged to express freely their findings and conclusions. Points of view or opinions do not, 

therefore, necessarily represent official ACL policy. 

Applicant Information

Please provide the following information as a part of the application for phase one and two of 

the TCMI Learning Collaborative.

Applicant Organization

o1. Nutrition Provider E-Mail: 

__________________________________________________

o2. Nutrition Provider “applicant” Name: 

__________________________________________________

o3. Nutrition Provider Address: 

__________________________________________________

o4. Nutrition Provider Phone Number: 

__________________________________________________

o5. Organization Website and/or social media: 

__________________________________________________
Affiliated Area Agency on Aging

o 6. Affiliated “sponsor” Area Agency on Aging: __________________________

o 7. AAA Mentor “staff lead” Name: ___________________________________

o 8. AAA Mentor Title: ______________________________________________

o 9. AAA Mentor Address: ___________________________________________

o 10. AAA Mentor Phone Number: _____________________________________

o 11. AAA Mentor E-Mail: _____________________________________________

Congregate Meal Program Description

12. In which Texas counties does your organization serve congregate meals?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

13. How many congregate meals did you serve in Fiscal Year 2019? 

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________
14. How many unduplicated congregate participants did you serve in Fiscal Year 2019?

o Total Unduplicated Congregate Participants? 

__________________________________________________

o Minority Unduplicated Congregate Participants? 

__________________________________________________

oLow-Income Unduplicated Congregate Participants? 

__________________________________________________

o Rural Unduplicated Congregate Participants? 

__________________________________________________

15. How many congregate meal sites did your organization serve prior to COVID-19? 

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________
16. Where were the congregate meals served by your organization before COVID-19? (Please 

check all that apply)

▢ Senior centers (building dedicated to senior activities including meals) 

▢ Multi-purpose community centers 

▢ Faith-based organizations or churches 

▢ Community supported meeting rooms or buildings (city or county) 

▢ Senior housing 

▢ Restaurant 

▢ Grocery store 

▢ Cafe 

▢ School 

▢ Other, please specify below: 

__________________________________________________
17. Where are the congregate meals currently served by your organization? (Please check 

all that apply)

▢ Senior centers (building dedicated to senior activities including meals) 

▢ Multi-purpose community centers 

▢ Faith-based organizations or churches 

▢ Community supported meeting rooms or buildings (city or county) 

▢ Senior housing 

▢ Restaurant 

▢ Grocery store 

▢ Cafe 

▢ School 

▢ Other, please specify below: 

__________________________________________________
18. In addition to Title III C-1 funding, what other financial resources support your 

congregate program activities? (Please check all that apply)

▢ Only Title III C-1 funding and participant contributions for meals 

▢ City or County funds 

▢ Fees charged for programs or activities provided 

▢ Businesses or community support 

▢ Fundraising/Special Events 

▢ Fundraising Drives or Direct Mail Campaigns 

▢ Foundations or grants 

▢ OAA Title III D evidence-based programs 

▢ Other, please specify below: 

__________________________________________________
19. Do you currently have partnerships or collaborations established at the community level 

to support a congregate meal program? 

o Yes 

o No

20. In the last several years (excluding the current year’s COVID-19 pandemic), have you 

seen participation in the congregate meal program:

o Declined significantly 

o Declined slightly 

o Remained the same 

oIncreased slightly 

oIncreased significantly

21. Have you implemented new practices or activities to attract new participants to any of 

your congregate meal program site(s) within the last two years?

o No new practices implemented during the last two years 

o New practices or activities implemented but did not increase number of participants 

o New practices or activities implemented did increase number of participants
Letter of Support

Please attach a letter of support with your application from your affiliated (“sponsor”) AAA. The 

letter must include the commitment of the AAA to:

o Identify a staff lead person from sponsoring AAA who will serve as the (“mentor”) or guide 

for the nutrition provider (“applicant”) while participating in the TCMI Learning 

Collaborative.

o Participate in the virtual learning collaborative workshop(s) with the nutrition provider.

o Provide necessary guidance to the participating provider throughout the duration of the 

TCMI learning collaborative.
Organizational Signatures

Click the link below to download the organizational signatures form. Please have the Mentor 

from your organization and the Executive Director of your organization verify the statements and 

complete the form.

Organizational Signatures Form

Please upload your completed signature form here:

As the applicant, I commit to the TCMI Learning Collaborative’s participation requirements.

o Name __________________________________________________

o Date __________________________________________________

Signature
Appendix B – Simple Logic Model Template
SIMPLE LOGIC MODEL TEMPLATE

Disclaimer: This project was supported, in part by grant number 90INNU0013, from the Administration 

for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees 

undertaking projects with government sponsorship are encouraged to express freely their findings and 

conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy. 

Innovative Congregate Pilot Program Goal: 

INPUTS ACTIVITIES OUTPUT OUTCOME

WHAT WE INVEST WHAT WE DO WHO WE REACH

WHAT HAPPENS? What’s the 

result of the project/What 

happens

• Staff

• Volunteers

• Time & Money

• Partners

• Material

• Technology

• Equipment

• Research 

findings

• Deliver services

• Conduct meetings

• Develop products

• Implement 

innovations

• Work with media

• Facilitate access to 

program

• Program participants

/ clients / customers

• AAAs

• Community based 

organizations

• Partners

• Decision makers

• Satisfaction

• Wellness

• Awareness

• Engagement

• Knowledge

• Motivations

• Reach

• Social integration

• Visibility

• Value

• Skills
Appendix C – TCMI Innovative Pilot RFP

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Executive Summary

As a part of the Texas Congregate Meal Initiative (TCMI) project funded by the Administration for 

Community Living (ACL) and the Texas Health and Human Services Commission (HHSC), the Public 

Policy Research Institute (PPRI) at Texas A&M University requests a proposal for an innovative lowcost congregate meal pilot project from each of the 16 selected Learning Collaborative (LC) 

participants. All these LC participants belong to the Texas aging nutrition provider network and are 

selected by the Texas HHSC to participate in the TCMI LC through a previous application process. 

With the support of the LC, the pilots would be assisted to exhibit innovative and promising practices 

that can be scaled across Texas. 

Pre-Proposal Technical Assistance 

The Workbook Questions connected with each session of the TCMI Virtual Workshop hosted by PPRI 

in October 2020 provide the necessary guidance to applicants so they can develop the various 

sections of their pilot proposal. Additionally, from November 2, 2020 to February 15, 2021, PPRI will 

hold technical assistance (TA) office hours for LC applicants seeking guidance to develop this 

proposal. These office hours will be held on all working Fridays from 1 pm to 2 pm over zoom 

virtual sessions. Guidance will be provided based on applicant needs. Applicants are requested to 

email ajackson@ppri,tamu,edu with a prior indication that they will attend a TA session to discuss 

questions about the pilot proposal. Inquiries and comments must reference TCMI.

Proposal Background

The Texas Congregate Meal Initiative funded by the ACL (2019-2022) has been conducting research 

to identify the causes of decline in congregate meal program participation by adult Texans 60 and 

over. During Year 1 of the project, PPRI at Texas A&M University has conducted several stakeholder 

surveys and focus groups to identify the facilitators and barriers to the congregate meal programs 

across Texas and innovations that have been tried in various communities representing the 28 Texas 

Area Agencies on Aging to address and impact social isolation of the Older adults and decreased 

participation in the congregate meal programs. Integrating the comprehensive statewide data, 

during Year 2, the TCMI is providing 16 select members of the Texas aging nutrition provider 

networks with business acumen, project development training as well as the opportunity to pilot 

low-cost innovations with the support of a Learning Collaborative (LC). The providers determined to 

have innovative plans will get the final opportunity to pilot their proposals and demonstrate their 

efficacy, prior to disseminating effectiveness lessons and replication insights on a national scale. The 

LC will provide participants the unique opportunity to not only learn from each other through a 

community of practice but also to influence the trajectory of the congregate meal programs across 
2 | Page

Texas and showcase local Texas innovations and replication possibilities to the nation. Resources 

available from the TCMI Learning Collaborative can be found at https://ppri.tamu.edu/tcmi. 

Proposal Submission

All proposals must be sent as a MS Word Document via email to the following address: 

ajackson@ppri.tamu.edu. The subject line should refer to TCMI Innovation Pilot. The email 

should reach the designated address by 5 PM CT on Monday, February 22.

Award Information & Payment Terms

Award notifications will be sent to applicants on or before April 30, 2021. To implement the approved 

pilots, each applicant will receive an initial payment of $5,000 in June 2021 and a second payment of 

$2,500 in December 2021 during the wrapping up of the pilot projects. Please note that these two 

fixed payments are made on a set schedule assuming required commitment to pilot projects are met 

by the awardees. 

Eligibility Information

Only the 16 selected Texas nutrition providers chosen to participate in the TCMI Learning 

Collaborative are eligible to submit a proposal to implement a low-cost innovative congregate meal 

pilot in their respective target communities. These providers were selected on September 30, 2020 

based on a previous application submitted to Texas HHSC for participating in the Learning 

Collaborative phase of the TCMI.

Proposal Requirements

This section describes what the proposal application package should include. PPRI & Texas HHSC 

may reject a proposal that fails to include the application requirements. PPRI may seek clarification 

and revisions from an applicant at any time during the evaluation period, and failure to respond 

may be cause for rejection of a TCMI innovation pilot proposal. The applicant shall be as precise, 

accurate, and succinct as possible and not exceed six double-spaced pages (using a font type no 

smaller than 11-point Times New Roman) to submit the following requested information. 

A. Applicant Information

1. Applicant Name, Position, Email Address & Contact Phone

2. Applicant Organization Name & Address 

3. Applicant Mentor Name, Title & Contact Phone

4. Applicant’s Area Agency on Aging

5. Total Budget Requested: This needs to equal $7,500. 

B. Abstract

The abstract should provide a brief description of the proposed congregate meal innovative pilot 

project, summarize its purposes and goals and what is aimed to be achieved with the help of the 

project in the applicant’s targeted geographical area. Abstract needs to clearly outline what makes 

the project innovative. The abstract should be written for a general public audience in 250 words or 

less. (5 points) 

C. Project Narrative 

The project narrative, as key part of the proposal, should provide the details of the proposed 

innovative congregate meal pilot and contain the information outlined in the table below. 
3 | Page

D. Budget

Applicants are required to provide a simple budget, with narrative, that includes a plan to spend a 

fixed sum of $7,500 for the implementation of the proposed innovative pilot over a period of seven 

months. The budget must be complete, reasonable, and directly related to the proposed project 

activities and tasks. Funding cannot be used for meal costs, construction or any rehabilitation of 

buildings. Budget may include projected expenditures for personnel, materials and supplies, any 

other direct costs including contractors, entertainment or activity fees, any marketing costs including 

brochures, newspapers ads etc. Continuation of existing projects in applicant’s jurisdiction will be 

allowed only with the expansion, enhancement and/or addition of new and innovative approaches 

in adherence to prohibitions imposed by the ACL grant conditions. (10 points)

E. Attachments Index

Applicants are advised not to include any other attachment with the proposal than what is specified 

below. These attachments are not included in the 6-page limit mentioned in page 3 of this 

document. 

E1. A logic model as a one-page figure that presents the conceptual framework for the proposed 

innovative pilot project. Template is provided in TCMI Virtual Workshop Day 3.

E2. A letter of support from the applicant’s Area Agency on Aging that specifically indicates a 

commitment to the innovative pilot including any resource commitment to the project (e.g., in-kind 

services, staff, space, equipment etc.).

E3. A one-page budget sheet as necessary. 

Selection Procedure

PPRI staff, in partnership with Texas HHSC staff, will review all proposals for completeness and 

basic responsiveness to the solicitation. Applicants are encouraged to work closely with PPRI staff 

and subject matter experts and take advantage of the Pre-Proposal Technical Assistance Office 

Hours explained in page 1 of this solicitation. Evaluation criteria: Abstract (5%), Project Narrative 

(85%) & Budget (10%). 

Selected Pilot Project Commitment

Approved pilot project implementers will commit to the following activities:

1) Implement pilot projects according to the approved plans over a 7-month period from June 

2021 to December 2021. 

2) Participate in a monthly virtual meeting with HHSC and PPRI during implementation/ piloting 

of their approved pilot projects. Share lessons learned on a regular basis with other members 

of the TCMI Learning Collaborative.

3) Coordinate with Texas A&M PPRI to collect and report data for outcome tracking and 

evaluation of their pilot projects.

4) Submit a 4-page project report to PPRI by January 31, 2022 based on an agreed upon format.

The Texas Congregate Meal Initiative (TCMI) is supported, in part by grant number 90INNU0013,

from the U.S. Administration for Community Living, Department of Health and Human Services,
1 | Page

Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are 

encouraged to express freely their findings and conclusions. Points of view or opinions do 

not, therefore, necessarily represent official ACL policy.

Disclaimer: This project was supported, in part by grant number 90INNU0013, from 

the Administration for Community Living, U.S. Department of Health and Human Services, 

Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are 

encouraged to express freely their findings and conclusions. Points of view or opinions do 

not, therefore, necessarily represent official ACL policy. 
Appendix D – Dashboard Examples
Example TCMI Data Dashboard Snapshot
Disclaimer: This project was supported, in part by grant number 90INNU0013, from the Administration for Community Living, U.S. Department of 

Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express 

freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy. 
Appendix E – TCMI Program Manager Survey
Page 1 of 13

TCMI Program Manager Survey

Disclaimer: This project was supported, in part by grant number 90INNU0013, from the 

Administration for Community Living, U.S. Department of Health and Human Services, 

Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are 

encouraged to express freely their findings and conclusions. Points of view or opinions do not, 

therefore, necessarily represent official ACL policy. 

Contact

Contact Please provide the following information:

o Site/Program Name: ___________________________________

o City: ________________________________________________

Participation

P0 Is your congregate site open?

o Yes, at all locations (Select this option if your program only serves one location) 

o Yes, at some locations 

o No

P1 How many congregate clients did you serve per day on average in the month of 

December 2021?

o Home delivered meals ________________________________________

o Grab and go meals ___________________________________________

o Congregate Site In-person _____________________________________
Page 2 of 13

P3 Does your TCMI pilot target any of the special populations below?

Please select all that apply.

▢ Individuals residing in rural areas

▢ Individuals with physical or mental disabilities

▢ Individuals at or below the poverty line

▢ Individuals with language barriers

▢ Specific ethnic groups

▢ Other special population

Display This Question: If P3 = Other special population

P3a What is the other special population targeted by your TCMI pilot?

________________________________________________________________

P4! Do you think your TCMI pilot has increased congregate meal access to vulnerable underserved Older Adult clients?

o No (21) 

o Yes (22)

P5! Do you think Older American clients visiting your sites and/or participating in the pilots value 

the TCMI pilot?

o No (21) 

o Yes (22) 
Page 3 of 13

Community Partnership

CP1 For your congregate programs, what types of community groups did you collaborate or 

partner with prior to planning the TCMI pilot? Please select all that apply.

□ Healthcare providers

□ Local schools, colleges or universities

□ Mental health agencies

□ Local government run entities such as libraries and health departments

□ Youth groups

□ Local media

□ Local restaurants, grocery stores, chefs, nutritionists

□ Food banks or food pantries

□ YMCA or other gym/recreational facilities

□ Civic groups such as Lions club, Rotary

□ Faith-based groups

□ Texas A&M Agrilife Extension

□ SNAP

□ TeXercise 

□ Other

Display This Question: If CP1 = Other

CP1a Who were the other partners you had for your congregate program prior to planning the 

TCMI pilot?

________________________________________________________________

________________________________________________________________

________________________________________________________________
Page 4 of 13

CP2 Which types of community partners (new or old) are you collaborating with from your 

community or beyond for the TCMI pilots? Please select all that apply.

□ Healthcare providers

□ Local schools, colleges or universities

□ Mental health agencies

□ Local government run entities such as libraries and health departments

□ Youth groups

□ Local media

□ Local restaurants, grocery stores, chefs, nutritionists

□ Food banks or food pantries

□ YMCA or other gym/recreational facilities

□ Civic groups such as Lions club, Rotary

□ Faith-based groups

□ Texas A&M Agrilife Extension

□ SNAP

□ TeXercise 

□ Other

Display This Question:If CP2 = Other

CP2a Who are your other partners you are working with for the TCMI pilots?

________________________________________________________________

________________________________________________________________

________________________________________________________________
Page 5 of 13

CP3 Are any of your community partners providing financial support or donations for your 

program?

o No

o Yes

Display This Question: If CP3 = Yes

CP3a What types of support are provided and by whom?

________________________________________________________________

CP4 Which of these partnerships would you like to mark as a valuable partnership and why?

________________________________________________________________

CP5 Do you feel your TCMI pilot has helped develop valuable community partnerships for you?

o No

o Yes

CP6 Do you feel the community partnerships created by the TCMI pilot are benefiting your 

program goals?

o No

o Yes
Page 6 of 13

Marketing

M3 Which of the following methods have you used specifically to market your TCMI pilot? 

Please select all that apply.

□ Paper flyers, brochures, leaflets 

□ Social media (Facebook, Instagram, Twitter, etc)

□ Other websites such as blogs or municipal sites

□ Radio

□ Television

□ Billboards

□ Mail outs

□ Word of mouth

□ Events such as parades or public meetings

□ Face to face (in person or virtual)

□ Networking/Personal connections

□ Other

Display This Question:If M3 = Other

M3a Please list the other marketing strategies you have used to advertise or market your TCMI 

pilot.

________________________________________________________________

M4 Of the marketing and branding material you created for the TCMI pilot so far, which one is 

your strongest or most valuable and why?

________________________________________________________________

M5 Of the marketing and branding events you have held for the project so far, which one is 

your strongest or most valuable and why?

________________________________________________________________
Page 7 of 13

M6 Do you think clients visiting your sites and/or participating in the TCMI pilot value the pilot 

and view it as beneficial?

o No

o Yes

M8 Because of your TCMI marketing and awareness building efforts, do you think that your 

community is more aware of the congregate program now compared to October 2021? 

o No

o Yes

Personnel and Resources

R1 Including yourself, how many full time staff or other personnel are supporting the 

implementation of your innovative pilot?

o Full time employees ________________________________________

o Part time employees ________________________________________

o Volunteers ________________________________________________

R2 Approximately how many hours per week do your volunteers spend working at your 

congregate meal location?

________________________________________________________________

R3 Do you think congregate staff at your site understand the purpose and potential benefits of 

the TCMI pilot?

o No

o Yes

R4 How many older adult volunteers do you have working as advocates or ambassadors for 

your programs?

________________________________________________________________
Page 8 of 13

R5 Has the TCMI pilot planning encouraged you to think more about your staffing and 

resources?

o No

o Yes

R6 Do you plan to use any of the following resources to support your TCMI pilot activities? 

Please select all that apply.

□ None of these 

□ Computers, tablets, smart phones

□ Video conferencing services such as Zoom or Teams 

□ Online streaming services such as Facebook live 

Skip To: R7 If R6 = None of these

R6a Do you have staff or volunteers specifically trained to deal with these technologies?

o No

o Yes

R7 Does your TCMI pilot target improvements in the setting of your congregate meal activities? 

(Did you change the chairs, tables, decorations, etc.)

o No

o Yes

R8 Are you using funds or donations from other sources in addition to the $7,500 from the 

project to support your TCMI pilot?

o No

o Yes

Display This Question:If R8 = Yes

R8a What are the other funding sources and how much are they providing?

________________________________________________________________
Page 9 of 13

Transportation

T1 Before the pandemic lockdowns, were your clients using any of the following transportation 

methods to reach your congregate site(s)? Please select all that apply.

□ Public transportation such as city busses or rail 

□ Transportation provided by congregate meal locations or government funded

□ Transportation sponsored by non-government organizations (taxis, Uber, volunteers)

T2 During TCMI pilot implementation, is government and/or non-government transportation 

offered?

o Yes

o Yes, but to a lesser degree

o No

oI don't know

Start of Block: Client Survey Matching

CS_12 Do you feel that participating in the congregate program helps increase your 

participants' social connection opportunities with others?

o Yes, often

o Yes, some of the time

o No, hardly ever

CS_15 Do you feel that participating in the congregate meal program helps your participants 

access healthy meals and makes them feel more food secured?

o Yes, often

o Yes, some of the time

o No, hardly ever

CS_17 Do you feel that participating in the congregate program makes your participants feel 

less sad and anxious?

o Yes, often

o Yes, some of the time

o No, hardly ever
Page 10 of 13

CS_19 Do you feel that participating in the congregate program made your participants feel 

better?

o Yes, mostly

o Yes, somewhat

o No, not better at all

TCMI Support

S1 How helpful were the following in your TCMI pilot implementation to date?
Page 11 of 13

S2 What has been most helpful from the TCMI project assistance for your pilot in the area of 

Innovations Thinking?

________________________________________________________________

S3 Are you looking forward to learning from TCMI sites implementing similar types of pilots as 

your own pilot?

o No

o Maybe

o Yes

S4 Have you used the materials offered on www.ppri.tamu.edu/tcmi to help you think about your 

TCMI pilot?

o No

o Maybe

o Yes 

S5 Did your congregate meal make a policy change due to the pilot? (Did you change your 

hours, your way of serving, your staffing, etc.)

o No 

o Not yet, but we will make changes

o Yes
Page 12 of 13

Covid

Cov-1 Have you made any changes to the following components at your congregate site to 

make the participant feel more COVID safe? Please select all that apply.

□ Meal Service

□ Location Enhancements 

□ Site Decorations

□ Staffing Additions

□ Special Staff Training

□ Social Distancing

□ Staggered Service

□ Rearrangement of Service Timings

□ Other

Display This Question: If Cov-1 = Other

Cov-2 What were the other changes you made to your congregate site to make participants feel

more COVID safe?

________________________________________________________________

Cov-3 Does the pandemic continue to negatively affect the implementation of your TCMI pilot?

o No

o Yes 

Cov-4 How has the pandemic altered your pilot implementation? (Please be specific regarding 

client and program impact)

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________
Page 13 of 13

Conclusion

C1 Other than the pandemic, what are your current two biggest challenges in implementing your 

TCMI pilot?

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

C2 What is a promising practice from your TCMI pilot so far from which similar sites in Texas 

can learn? (This can include anything you did while preparing to implement your pilot as well as 

implementation if you have already started)

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

C3A Has your site begun to implement some or all of the aspects of your TCMI pilot?

o No

o Yes 

C3 Is your site fully ready to implement all aspects of your TCMI pilot over the next few months 

at this time?

o No

o Yes
Appendix F – TCMI Client Survey
Today’s Date: _____________________

Page 1 of 4

Congregate Participant Survey

Disclaimer: This project was supported, in part by grant number 90INNU0013, from the 

Administration for Community Living, U.S. Department of Health and Human Services, 

Washington, D.C. 20201. Grantees undertaking projects with government sponsorship 

are encouraged to express freely their findings and conclusions. Points of view or 

opinions do not, therefore, necessarily represent official ACL policy. 

The following survey contains questions about you, our congregate program and the 

people we serve in our congregate program. 

The program in which you are participating is part of a statewide effort to improve similar 

congregate programs in which Older Americans participate. As such, your response will 

be valuable in helping the state decision makers to understand what works and what does 

not work in these programs. 

Please take as much time needed to complete the survey. If you are not comfortable with 

any question, please keep it blank. Thank you!

1) What is your age?

_____________

2) Which gender do you identify 

with? 

o Female

o Male

o Other ____________________

3) Is the current total annual income 

for your household below 

$17,000? 

o Yes

o No

4) Have you ever served in the US 

Armed Forces? 

o Yes

o No

5) Which of the following best 

describes your racial and ethnic 

background? (Select all that apply)

□ White

□ Black or African American

□ Hispanic or Latino

□ American Indian or Alaska 

Native

□ Asian

□ Native Hawaiian or Pacific 

Islander

□ Other ____________________

6) Do you live in rural or urban area 

of Texas? 

o Rural

o Urban
Congregate Participant Survey

Page 2 of 4

7) Have you attended any 

congregate or senior meal service 

program in your area before 

October 2021?

o Yes

o No

o I don’t know

8) Do you feel the COVID-19 

pandemic increased challenges to 

participate in the congregate 

programs?

o Yes

o No

o I don’t know

9) How do you get to the congregate 

program in which you currently 

participate?

o I walk

o I use transportation provided by 

program

o I use transportation not provided 

by program

10) How did you hear about the 

congregate program in which you 

currently participate? (Select all 

that apply)

□ Flyers

□ Social Media

□ Friend or family

□ Newspaper

□ Radio

□ Television

□ Billboard

□ Other _____________________

11) Over the past 12 months, how 

often have you felt alone and 

isolated from others?

o Often

o Some of the time

o Hardly ever

12) Do you feel that participating in 

the congregate program helped 

increase your social connection 

opportunities with others?

o Yes, helped often

o Helped only some of the time

o No, helped hardly ever

13) Do you see friends more often 

because of participating in the 

congregate program?

o Yes

o No

14) Over the past 12 months, how 

often did you have to skip meals 

or cut the size of your meals 

because you did not have enough 

money for healthy meals?

o Often

o Some of the time

o Hardly ever

15) Do you feel that participating in 

the congregate meal program 

helped you access healthy meals

and make you feel more food 

secured? 

o Yes, helped often

o Helped only some of the time

o No, hardly ever helped
Congregate Participant Survey

Page 3 of 4

16) Over the past 12 months, how 

often did you generally feel sad 

and anxious? 

o Often

o Some of the time

o Hardly ever

17) Do you feel that participating in 

the congregate program made 

you feel less sad and anxious?

o Yes, often

o Only some of the time

o No, hardly ever 

18) Over the past 12 months, how 

often did you generally feel not 

well? 

o Often

o Some of the time

o Hardly ever

19) Do you feel that participating in 

the congregate program made 

you feel better? 

o Yes, mostly better

o Somewhat better

o No, not better at all

How do you rate the following?

 

20) Courteousness and friendliness 

of staff who are providing the 

congregate program in which you 

are participating. 

o Excellent

o Good

o Fair

o Could be better

21) Increased social connection 

opportunity with friends or fellow 

older American participants in 

the congregate meal program.

o Excellent

o Good

o Fair

o Could be better

22) Overall ambience in which the

program serves meals or offers

activities.

o Excellent

o Good

o Fair

o Could be better

23) Overall program quality for the 

congregate program in which you 

participate. 

o Excellent

o Good

o Fair

o Could be better
Congregate Participant Survey

Page 4 of 4

24) The activity or group of activities 

offered by the program in which 

you are participating. (ex: health 

and wellness, craft, technology, 

fitness, wellness checks, music 

events, cooking, nutritional 

awareness, health awareness, guest 

speakers etc.)

o Excellent

o Good

o Fair

o Could be better

25) Marketing and/or branding 

activities to spread awareness 

about the program in the 

community. 

o Excellent

o Good

o Fair

o Could be better

26) The quality of the meals offered 

by the congregate program. 

o Excellent

o Good

o Fair

o Could be better

27) Do you think the congregate 

program in which you 

participated could be beneficial 

for the older adults in your 

community?

o Extremely beneficial

o Somewhat beneficial

o Not at all beneficial

28) Would you recommend the

program in which you 

participated to others in your 

community?

o Yes

o No

o I don’t know

29) What do you recommend to 

increase participation in these types 

of congregate meal programs in your 

community?

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

30) Would you want to talk to us 

more about the program in which you 

participated? If so, please tell us how 

to contact you.

Name: 

________________________________

Phone: 

________________________________

Email: 

________________________________