Family Network Survey

Your opinion matters!

The Care & Share Family Network is family and friends of individuals with disabilities. Our network will build connections, encourage positive conversations, share information and learning, and offer a safe place for families to be inspired to dream big.

The Family Network is created by families, for families.

The Care and Share Family network would like to find out what local caregivers want and need from a network.

Caregivers of individuals with a disability are being invited to complete this survey.

Thank you for taking the time to participate.

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* 1. What is the age of your family member with a disability?

Preschool age

School age

18 years and older

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* 2. Does your family member live with you?

Yes

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* 3. What community do you live in or live closest to?

Sarnia

Chatham

Wallaceburg

Other (please specify)

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* 4. Have you participated in a family network in the past?

Yes

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* 5. If yes, was the network helpful?

yes

Please explain:

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* 6. What would the ideal family network look like to you? Choose all that apply.

opportunity for families with common interests to gather

a chance to give and get emotional support

opportunity to learn about topics relevant to your family's situation

informal get together to chat over a cup of coffee

Other (please specify)

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* 7. Would you prefer a family network group that:

meets online

meets in person

offers an opportunity to do both

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* 8. Are you likely to attend an event that focuses on any of these particular topics?
Please number these topics in order of preference from 1 to 9.
Under Other please specify additional topics that would interest you.

Education - creating positive school experiences

Financial topics - disability tax credit deduction; RRSP; disability benefits (ODSP)

Transition from school to life in the community

Empowering people - gaining independence

Moving to a home of my own

Employment opportunities and employment support

Rights and responsibilities

Facts about a specific disability

Other (please specify below)

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* 9. Please specify other topics or areas of interest

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* 10. What would make it easier for you to attend an event?

Shared transportation to and from the event

Other (please specify)

The Advisory Committee is eager to learn what a Family Network group can offer you. They can be contacted directly by email at the end of the survey.

As with all questions on the survey this section is optional. You may complete this area in full, in part or not at all. This information will be held as confidential and it will not be shared with anyone outside of the steering committee.

MAY WE CONTACT YOU?

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* 11. What is your preferred language?

English

French

Other (please specify)

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* 12. What is the best way to communicate with you?

E-mail

Telephone

Text (please provide a cell number above)

Regular Mail

Other (please specify)

Thank you for taking the time to complete this survey.

For more information about the Care and Share Family Network you are encouraged to visit the website
www.careandsharefamilynetwork.ca
or email our general mailbox at
careandsharefamilynetwork@gmail.com

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* 13. Provide any information you may wish to share:

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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* 1. What is the age of your family member with a disability?

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* 2. Does your family member live with you?

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* 3. What community do you live in or live closest to?

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* 4. Have you participated in a family network in the past?

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* 5. If yes, was the network helpful?

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* 6. What would the ideal family network look like to you? Choose all that apply.

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* 7. Would you prefer a family network group that:

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* 8. Are you likely to attend an event that focuses on any of these particular topics? Please number these topics in order of preference from 1 to 9. Under Other please specify additional topics that would interest you.

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* 9. Please specify other topics or areas of interest

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* 10. What would make it easier for you to attend an event?

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* 11. What is your preferred language?

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* 12. What is the best way to communicate with you?

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* 13. Provide any information you may wish to share:

* 8. Are you likely to attend an event that focuses on any of these particular topics?
Please number these topics in order of preference from 1 to 9.
Under Other please specify additional topics that would interest you.