Common Threads Network of Southwest Ohio
4th Annual State News
Wednesday, October 18, 2017
Warren Center Warren County

YES! I will be there for this special session.

Please register only 1 person per survey.

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* 1. Full Name

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* 2. Phone to reach you regarding this event.

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* 3. E-mail address to reach you regarding this event & for updates about future events.

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* 4. Which best describes you?

Family member caring for someone with an intellectual/developmental/other disability

Professional serving people with disabilities

Person with a developmental disability

If other, please specify

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* 5. If you are a family member, which of these best describes you?

Parent

Sibling

Grandparent

Other

If other , please specify)

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* 6.
FAMILIES, in what county is your family member served?

PROFESSIONALS, in what county are you employed?

Adams

Butler

Brown

Clark

Clermont

Clinton

Darke

Fayette

Greene

Hamilton

Highland

Miami

Montgomery

Preble

Warren

Other

If other, please specify

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* 7. Age of your family member with a developmental disability (or if so, you)?

Birth to 2 years old

3 to 5 years old

6 to 13 years old

14 to 22 years old

23 to 35 years old

36 to 55 years old

56 to 70 years old

Over 70 years old

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* 8. Is this your first Common Threads Network session?

Yes

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* 9. How did you hear about this information session?

FaceBook

Website

Other

If other, please explain

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* 10. What do you hope to learn by attending this Common Threads Network information session?

Question Title

* 11. Accommodations

Yes, I will need accommodations. Please explain in comment box.

No special accommodations required.

Please explain needed accommodations

Question Title

* 1. Full Name

Question Title

* 2. Phone to reach you regarding this event.

Question Title

* 3. E-mail address to reach you regarding this event & for updates about future events.

Question Title

* 4. Which best describes you?

Question Title

* 5. If you are a family member, which of these best describes you?

Question Title

* 6. FAMILIES, in what county is your family member served?PROFESSIONALS, in what county are you employed?

Question Title

* 7. Age of your family member with a developmental disability (or if so, you)?

Question Title

* 8. Is this your first Common Threads Network session?

Question Title

* 9. How did you hear about this information session?

Question Title

* 10. What do you hope to learn by attending this Common Threads Network information session?

Question Title

* 11. Accommodations

* 6.
FAMILIES, in what county is your family member served?

PROFESSIONALS, in what county are you employed?