Disability Resource Center
27 Congress St. Suite 107
Salem MA, 01970
978-741-0077
www.disabilityrc.org

The purpose of this survey is to assess the needs of the community in response to the Coronavirus (COVID-19). All survey responses are confidential and we will not share your information with anyone outside of the agency. If you or someone you know is in need of assistance, please contact our office for support. Thank you!

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* 1. Are you a person with a disability?

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* 2. Your contact information

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* 3. Preferred method of contact

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* 4. Do you have access to the internet?

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* 5. Have you encountered barriers during COVID-19?

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* 6. Which items have been hard for you to access?

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* 7. Which services have been hard for you to access?

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* 8. If applicable, how would you prefer something to be delivered to you?

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* 9. Additional information you'd like to share

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* 10. Would you like to learn more about our services?

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