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* 1. In the past year, what kind of help did you get from Disability Resource Center? Check the box next to help you received this year.

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* 2. Did Disability Resource Center help you with something not listed above?  
 Please describe:  

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* 3. Do you have an Independent Living Plan?

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* 4. If you have an Independent Living Plan (ILP),  
what was most important in developing your plan?  Check only one.  

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* 5. I received assistance immediately

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* 6. My phone calls are returned promptly by  Disability Resource Center

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* 7. Disability Resource Center treats me with respect

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* 8. I would recommend Disability Resource Center to a friend or family member

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* 9. I am happy with the quality of services I receive from Disability Resource Center

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* 10. How has Disability Resource Center helped you? 

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* 11. What else could Disability Resource Center do to help you live independently? 

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* 12. The following questions are optional

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* 13. What language do you speak at home?

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* 14. How well do you speak English?

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* 15. How old are you?

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* 16. Are you Hispanic or Latino?

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* 17. What is your race?  Check all that apply 

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* 18. What is your gender?

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* 19. If you need assistance immediately or wish to be entered into the raffle for a $50.00 gift card, please include your name and a phone number or email address to reach you at.

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