Advocacy Day Needs Assessment

Thank you for taking the time to complete this survey. It is designed to measure barriers in the community for people with disabilities so that the South Carolina Access & Independence Network can collaborate to remove them. Your input is important! Responses are anonymous.

Question Title

* 1. What is your zip code?

Question Title

* 2. What is your gender?

Prefer not to answer

Male

Female

Other (please specify)

Question Title

* 3. How old are you?

Prefer not to answer

Under 5

5-15

16-24

25-44

45-64

65 and older

Question Title

* 4. What is your ethnicity? (Check all that apply)

Prefer not to answer

American Indian or Alaskan Native

Asian

Black/African American

Caucasian

Hispanic/Latino

Native Hawaiian/Pacific Islander

Other (please specify)

Question Title

* 5. What is your connection to disability?

I am a person with a disability

I am a parent of a child with a disability

I am an ally of the disability community