Membership Survey

1. How long have you been a member of the Down Syndrome Association of Hampton roads (DSAHR)?

How long have you been a member of the Down Syndrome Association of Hampton roads (DSAHR)? less than 1 year

1-3 years

4-8 years

9 years or more

2. If you have a child (or children) with Down syndrome, what is his or her ages(s)? Self Advocates, please choose your age range.

If you have a child (or children) with Down syndrome, what is his or her ages(s)? Self Advocates, please choose your age range. 0-3

4-8

9-13

14-18

18 or Older

N/A

3. How did you initially hear about the DSAHR?

How did you initially hear about the DSAHR? Hospital

Pediatrician

Friend/Relative

Other (please specify)

4. How do you usually access information about the DSAHR, its upcoming events and activities?

How do you usually access information about the DSAHR, its upcoming events and activities? Website

Yahoo! Group

Newsletter

Facebook

Other (please specify)

5. How often do you attend DSAHR events?

How often do you attend DSAHR events? Once a year

Twice a year

Once a month

More than once a month

Do not attend any events

6. Tell us what you would like DSAHR to focus more or less on in the future.

	Focus More	Fine Right Now	Focus Less
Social Activities Parent	*Tell us what you would like DSAHR to focus more or less on in the future. Social Activities Parent Focus More	Social Activities Parent Fine Right Now	Social Activities Parent Focus Less
Educational activities	Educational activities Focus More	Educational activities Fine Right Now	Educational activities Focus Less
Advocacy/Awareness	Advocacy/Awareness Focus More	Advocacy/Awareness Fine Right Now	Advocacy/Awareness Focus Less

Other (please specify)

7. What types of entertainment would you like to see offered by DSAHR for your family on DSAHR sponsored Family Nights?

What types of entertainment would you like to see offered by DSAHR for your family on DSAHR sponsored Family Nights?

8. Please rate your interest in attending these educational workshops on the following topics if planned or co-sponsored by DSAHR.

	Very High	High	Low	Very Low
Therapeutic: Speech/Oral Motor	*Please rate your interest in attending these educational workshops on the following topics if planned or co-sponsored by DSAHR. Therapeutic: Speech/Oral Motor Very High	Therapeutic: Speech/Oral Motor High	Therapeutic: Speech/Oral Motor Low	Therapeutic: Speech/Oral Motor Very Low
Therapueutic: Occupational Therapy	Therapueutic: Occupational Therapy Very High	Therapueutic: Occupational Therapy High	Therapueutic: Occupational Therapy Low	Therapueutic: Occupational Therapy Very Low
Thereapeutic: Physical Therapy	Thereapeutic: Physical Therapy Very High	Thereapeutic: Physical Therapy High	Thereapeutic: Physical Therapy Low	Thereapeutic: Physical Therapy Very Low
Medical: Vision	Medical: Vision Very High	Medical: Vision High	Medical: Vision Low	Medical: Vision Very Low
Medical: Hearing	Medical: Hearing Very High	Medical: Hearing High	Medical: Hearing Low	Medical: Hearing Very Low
Medical: Digestive or liver/GI	Medical: Digestive or liver/GI Very High	Medical: Digestive or liver/GI High	Medical: Digestive or liver/GI Low	Medical: Digestive or liver/GI Very Low
Medical: Cardiac/Heart	Medical: Cardiac/Heart Very High	Medical: Cardiac/Heart High	Medical: Cardiac/Heart Low	Medical: Cardiac/Heart Very Low
Medical: Bones, joints, muscles	Medical: Bones, joints, muscles Very High	Medical: Bones, joints, muscles High	Medical: Bones, joints, muscles Low	Medical: Bones, joints, muscles Very Low
Medical: Nutrition	Medical: Nutrition Very High	Medical: Nutrition High	Medical: Nutrition Low	Medical: Nutrition Very Low
Medical: Respiratory/Breathing	Medical: Respiratory/Breathing Very High	Medical: Respiratory/Breathing High	Medical: Respiratory/Breathing Low	Medical: Respiratory/Breathing Very Low
Medical: Allergies/Sinuses	Medical: Allergies/Sinuses Very High	Medical: Allergies/Sinuses High	Medical: Allergies/Sinuses Low	Medical: Allergies/Sinuses Very Low
Medical: Cancer/Oncology	Medical: Cancer/Oncology Very High	Medical: Cancer/Oncology High	Medical: Cancer/Oncology Low	Medical: Cancer/Oncology Very Low
Medical: Neurology	Medical: Neurology Very High	Medical: Neurology High	Medical: Neurology Low	Medical: Neurology Very Low
School related issues: Individual Education Plans (IEP's)	School related issues: Individual Education Plans (IEP's) Very High	School related issues: Individual Education Plans (IEP's) High	School related issues: Individual Education Plans (IEP's) Low	School related issues: Individual Education Plans (IEP's) Very Low
School related issues: Least Restrictive Environment	School related issues: Least Restrictive Environment Very High	School related issues: Least Restrictive Environment High	School related issues: Least Restrictive Environment Low	School related issues: Least Restrictive Environment Very Low
School related issues: Transition	School related issues: Transition Very High	School related issues: Transition High	School related issues: Transition Low	School related issues: Transition Very Low
School related issues: Placement	School related issues: Placement Very High	School related issues: Placement High	School related issues: Placement Low	School related issues: Placement Very Low
Academics: Math	Academics: Math Very High	Academics: Math High	Academics: Math Low	Academics: Math Very Low
Academics: Writing	Academics: Writing Very High	Academics: Writing High	Academics: Writing Low	Academics: Writing Very Low
Academics: Reading	Academics: Reading Very High	Academics: Reading High	Academics: Reading Low	Academics: Reading Very Low
Other: Social skills	Other: Social skills Very High	Other: Social skills High	Other: Social skills Low	Other: Social skills Very Low
Other: Behavioral issues	Other: Behavioral issues Very High	Other: Behavioral issues High	Other: Behavioral issues Low	Other: Behavioral issues Very Low
Other: Potty training	Other: Potty training Very High	Other: Potty training High	Other: Potty training Low	Other: Potty training Very Low
Other: Financial Planning	Other: Financial Planning Very High	Other: Financial Planning High	Other: Financial Planning Low	Other: Financial Planning Very Low
Other: Medical Research	Other: Medical Research Very High	Other: Medical Research High	Other: Medical Research Low	Other: Medical Research Very Low
Other: Educational Research	Other: Educational Research Very High	Other: Educational Research High	Other: Educational Research Low	Other: Educational Research Very Low

Other (please specify)

9. In what capacity would you like to volunteer in? Check all you are interested.

In what capacity would you like to volunteer in? Check all you are interested. Buddy Walk

Holiday Party

Family Nights

Fest Events

When you need me, call me

Not interested in volunteering at this time

10. Thank you for completing our membership survey.

If you are interested in participating in our drawing for one of two $50 Visa cards, please provide us with your name and best way to contact you.

Thank you for completing our membership survey. If you are interested in participating in our drawing for one of two $50 Visa cards, please provide us with your name and best way to contact you.

Membership Survey
Exit this survey

1. Default Section

1. How long have you been a member of the Down Syndrome Association of Hampton roads (DSAHR)?

2. If you have a child (or children) with Down syndrome, what is his or her ages(s)? Self Advocates, please choose your age range.

3. How did you initially hear about the DSAHR?

4. How do you usually access information about the DSAHR, its upcoming events and activities?

5. How often do you attend DSAHR events?

6. Tell us what you would like DSAHR to focus more or less on in the future.

7. What types of entertainment would you like to see offered by DSAHR for your family on DSAHR sponsored Family Nights?

8. Please rate your interest in attending these educational workshops on the following topics if planned or co-sponsored by DSAHR.

9. In what capacity would you like to volunteer in? Check all you are interested.

10. Thank you for completing our membership survey.

If you are interested in participating in our drawing for one of two $50 Visa cards, please provide us with your name and best way to contact you.

Membership SurveyExit this survey

1. Default Section

1. How long have you been a member of the Down Syndrome Association of Hampton roads (DSAHR)?

2. If you have a child (or children) with Down syndrome, what is his or her ages(s)? Self Advocates, please choose your age range.

3. How did you initially hear about the DSAHR?

4. How do you usually access information about the DSAHR, its upcoming events and activities?

5. How often do you attend DSAHR events?

6. Tell us what you would like DSAHR to focus more or less on in the future.

7. What types of entertainment would you like to see offered by DSAHR for your family on DSAHR sponsored Family Nights?

8. Please rate your interest in attending these educational workshops on the following topics if planned or co-sponsored by DSAHR.

9. In what capacity would you like to volunteer in? Check all you are interested.

10. Thank you for completing our membership survey. If you are interested in participating in our drawing for one of two $50 Visa cards, please provide us with your name and best way to contact you.

Membership Survey
Exit this survey

10. Thank you for completing our membership survey.

If you are interested in participating in our drawing for one of two $50 Visa cards, please provide us with your name and best way to contact you.