ASACIC Programming Needs Survey Summer 2011

Autism Society of Central Illinois (ASACIC) Survey -- 2011

Please take a few moments to complete the following survey. Your input is valuable and will be used to improve the services provided by our local Autism Society Chapter.

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1. Please indicate your connection to autism and ASACIC.

Please indicate your connection to autism and ASACIC. Parent of a individual with autism

Caregiver to someone with autism

Individual with autism

Other family member

Therapy provider

Medical profession

Education profession

Concerned community member

Age of individual(s) with autism

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2. Please tell us your location (City and County).

Please tell us your location (City and County).

3. How do you learn about upcoming ASACIC events?

How do you learn about upcoming ASACIC events? Website Newsletter	Friend Emails
Other (please specify)

4. Do you find the information posted on the website helpful?

Do you find the information posted on the website helpful? Very helpful Somewhat helpful	Not helpful I don't visit the website
Suggestions for the website:

5. Please check the type of information would you like to see on the website and/or in the newsletter?

Please check the type of information would you like to see on the website and/or in the newsletter? Current local events Local Trainings/Workshops Local Resources Board Member Spotlight Article	Feedback from previous events Quarterly event calendar Camp and grant application forms Golf outing, Walk applications	Feature story on child/adult with autism Autism merchandise Legislative updates
Other (please specify)

6. Please rate the awareness/social activities sponsored by ASACIC (Take a Step for Autism Walk, Zoo Event, Movies, Swim Event, Golf Outing)?

Please rate the awareness/social activities sponsored by ASACIC (Take a Step for Autism Walk, Zoo Event, Movies, Swim Event, Golf Outing)? Great	Very Good	Good	Fair	Poor	Don't know
Additional comments:

7. Please rate ASACIC's programs (Support Group Meetings, Camp ASPIRE, Speakers on Autism, Workshops (education/IEP, therapy interventions, etc.) and Blake Penner financial grant).

Please rate ASACIC's programs (Support Group Meetings, Camp ASPIRE, Speakers on Autism, Workshops (education/IEP, therapy interventions, etc.) and Blake Penner financial grant). Great	Very Good	Good	Fair	Poor	Don't know
Additional comments? Please describe:

8. What do you see as the strengths of ASACIC? What aspects of ASACIC have benefitted you and your family the most?

What do you see as the strengths of ASACIC? What aspects of ASACIC have benefitted you and your family the most?

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9. What have been the most beneficial therapeutic activities or medical treatments for autism? Please describe your personal experience. (ASACIC or non-ASACIC sponsored.) For example, any educational, medical, or therapeutic treatment that you would recommend based on your experience?

What have been the most beneficial therapeutic activities or medical treatments for autism? Please describe your personal experience. (ASACIC or non-ASACIC sponsored.) For example, any educational, medical, or therapeutic treatment that you would recommend based on your experience?

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10. Please identify your needs or knowledge of others' needs in the following areas related to autism. (Note: This survey seeks to identify community needs and is not representative of the chapter's current or future services.)

	Current need	Possible future need	Past need	Not interested
Trained respite / caregiver	*Please identify your needs or knowledge of others' needs in the following areas related to autism. (Note: This survey seeks to identify community needs and is not representative of the chapter's current or future services.) Trained respite / caregiver Current need	Trained respite / caregiver Possible future need	Trained respite / caregiver Past need	Trained respite / caregiver Not interested
Government program information	Government program information Current need	Government program information Possible future need	Government program information Past need	Government program information Not interested
Treatment options	Treatment options Current need	Treatment options Possible future need	Treatment options Past need	Treatment options Not interested
Therapy (ABA/Behavior, OT, etc.)	Therapy (ABA/Behavior, OT, etc.) Current need	Therapy (ABA/Behavior, OT, etc.) Possible future need	Therapy (ABA/Behavior, OT, etc.) Past need	Therapy (ABA/Behavior, OT, etc.) Not interested
Research information	Research information Current need	Research information Possible future need	Research information Past need	Research information Not interested
Recreational activities	Recreational activities Current need	Recreational activities Possible future need	Recreational activities Past need	Recreational activities Not interested
Educational Advocacy (IEP)	Educational Advocacy (IEP) Current need	Educational Advocacy (IEP) Possible future need	Educational Advocacy (IEP) Past need	Educational Advocacy (IEP) Not interested
Early Intervention Services	Early Intervention Services Current need	Early Intervention Services Possible future need	Early Intervention Services Past need	Early Intervention Services Not interested
Transition (employment, college, technical/vocational)	Transition (employment, college, technical/vocational) Current need	Transition (employment, college, technical/vocational) Possible future need	Transition (employment, college, technical/vocational) Past need	Transition (employment, college, technical/vocational) Not interested
Independent skills (potty training, safety, etc.)	Independent skills (potty training, safety, etc.) Current need	Independent skills (potty training, safety, etc.) Possible future need	Independent skills (potty training, safety, etc.) Past need	Independent skills (potty training, safety, etc.) Not interested
Social/communication	Social/communication Current need	Social/communication Possible future need	Social/communication Past need	Social/communication Not interested
Insurance Information and Advocacy (help)	Insurance Information and Advocacy (help) Current need	Insurance Information and Advocacy (help) Possible future need	Insurance Information and Advocacy (help) Past need	Insurance Information and Advocacy (help) Not interested
Adult housing information	Adult housing information Current need	Adult housing information Possible future need	Adult housing information Past need	Adult housing information Not interested

ASACIC Programming Needs Survey Summer 2011Exit this survey

Autism Society of Central Illinois (ASACIC) Survey -- 2011

*1. Please indicate your connection to autism and ASACIC.

*2. Please tell us your location (City and County).