Service Needs Survey

This survey is to help us identify unmet needs in our communities so we may help address those challenges.  Questions 1-9 are specific to the individual with an intellectual/developmental disability.  Questions 10 and 11 are specific to the caregiver.  

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* 1. What county do you live in

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* 2. Current living arrangement

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* 3. Current challenges keeping you from living where you want/unmet housing needs in your community: (mark all that apply)

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* 4. What do you currently do during the day (mark all that apply)

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* 5. Current challenges keeping you from doing what you want/Unmet needs in your community (mark all that apply)

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* 6. Do you currently use technology to meet needs, if so please describe the technology you use and what need it meets.

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* 7. Current challenges keeping you from using technology/Unmet needs in your community (mark all that apply)

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* 8. Areas of importance to you/Unmet needs in your community (Mark all that apply)

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* 9. Please rank accessibility in the following areas:

  Poor Good Excellent
Home
Community
Transportation
Public Buildings

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* 10. This question is specific to the caregiver: Do you feel your family unit has sufficient support to meet the needs of the individual with an intellectual/developmental disability?

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* 11. What needs do you as the caregiver have to ensure you can sufficiently support the individual with an intellectual/developmental disability?

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