2020-2021 DD Vision Survey- Self-Advocates

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* 1. Which region of Alaska do you live in?

NORTHERN REGION (Northwest Arctic Borough, North Slope Borough, Nome Census Area)

INTERIOR REGION (Yukon-Koyukuk Census Area, Fairbanks North Star Borough, Denali Borough, Southeast Fairbanks Census Area)

ANCHORAGE (Anchorage Municipality)

MAT-SU (Matanuska-Susitna Borough)

SOUTHWEST REGION (Kusilvak Census Area, Bethel Census Area, Dillingham Census Area, Bristol Bay Borough, Lake and Peninsula Borough, Aleutians East Borough, Aleutians West Census Area)

GULF COAST REGION (Valdez-Cordova Census Area, Kenai Peninsula Borough, Kodiak Island Borough)

SOUTHEAST REGION (Juneau, Sitka, Wrangell, Haines Borough, Ketchikan Borough, Skagway Borough, Yakutat Borough, the Prince of Wales-Hyder Census Area, Hoonah-Angoon Census Area, Petersburg Census Area)

I don't live in Alaska/Other (please specify)

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* 2. Race/ Ethnicity (select all that apply)

White

Black or African American

American Indian and Alaska Native

Hispanic/Latino

Asian

Native Hawaiian & Other Pacific Islander

Race unknown

Prefer to self-describe as:

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* 3. Gender

Male

Female

Prefer to self-describe as:

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* 4. Please check the category below that BEST describes your interest or involvement in disability issues:

Individual with a developmental disability

Family member of an individual with a developmental disability

Service Provider (management, administrative, etc.)

State Agency Staff

Direct Support Professionals

Care Coordinator

Other (please specify)