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Autism Answers Survey 1
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1.
In what city do you live?
(Required.)
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2.
At what email address would you like to be contacted?
(Required.)
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3.
Which race/ethnicity best describes you? (Please choose only one.)
(Required.)
American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Multiple ethnicity / Other (please specify)
4.
What is your approximate average household income?
$0 - $19,999
$20,000 - $39,999
$40,000 - $59,999
$60,000 - $79,999
$80,000 - $99,999
$100,000 - $119,999
$120,000 - $139,999
$140,000 - $159,999
$160,000 and up
5.
Which do you believe more money should be dedicated to?
Services
Research
6.
Does anyone in your household currently receive Medicaid benefits, or not?
Yes, someone does
No, no one does
7.
Please Rank from Your Child's Needs from 1-6 (1-most important 6-least important)
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
1
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
2
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
3
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
4
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
5
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
6
Housing
Medical/Treatment
Educational Services
Employment
Respite Services
Financial Assistance
Current Progress,
0 of 7 answered