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Senior Services Feedback - September 2019

  1. Senior Services Feedback

    The Ashfield Select Board would like to hear from all town citizens regarding the needs of seniors in the town. This feedback is intended to be used to address current and future needs and to better plan and appropriately finance desired senior services. Your contact information is optional and need not be entered.

  2. Optional Fields Section

    The fields in this section are optional and may be omitted. If you do share your name, contact info and/or street address they will not be published nor will they be used for any purposes other than as it relates to the senior services. Someone from the town hall staff may want to contact you to follow up or to get clarity on something that was entered.

  3. If entered this should be a valid Ashfield street address.

  4. Required Fields Section

    This section contains the required fields. It must be completed for the survey to be submitted.

  5. What senior service should be available in Ashfield? (Check all that apply) *

  6. Please provide an additional comments, suggestions or anything else that you deem necessary.

  7. May we contact you if we need to follow up on anything?*

  8. If you wish to follow up with the select board please send a brief email to

  9. Leave This Blank:

  10. This field is not part of the form submission.