DSAGSL Census - 2021

Thank you for completing the DSAGSL 2021 Census Survey. Just one person from each household needs to complete this survey and can add information for every member of their household.

DSAGSL is committed to being an inclusive community that serves all individuals with Down syndrome and their families. The information collected through the Census Survey will help DSAGSL update the membership database and better serve the Down syndrome community by securing additional grant funding, targeting communications, and identifying unmet needs.

All information collected is kept private and secure.

DSAGSL may contact you by phone to gather additional needed information.

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* 1. First and last name of person with Down syndrome:

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* 2. Please list the Parent(s) / Caregiver(s) of the person with Down syndrome and their relationship. *If person with Down syndrome lives in group setting, please list the parents/caregivers as well as indicate with what agency the person receives residential services.

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* 3. Mailing address for the individual with Down syndrome

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* 4. The DSAGSL sends valuable information and resources via email. Please include the best email address for your family:

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* 5. Best phone number for your family:

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* 6. Date of birth of the individual with Down syndrome (DD/MM/YYYY):

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* 7. How does the person with Down syndrome identify?

White or Caucasian

Black or African American

Hispanic or Latinx

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 8. Is the person with Down syndrome Hispanic / Latinx / of Spanish origin?

Yes

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* 9. Gender of the person with Down syndrome

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* 10. What is the primary language used by the household?

English

Spanish

Other (please specify)

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* 11. In what county is the household?

The answers to the follow questions will help DSAGSL improve communications, programming, and fulfill unmet needs.

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* 12. How familiar are you with the DSAGSL?

I try to stay up-to-date with all the latest news from the DSAGSL.

I have a good idea of what the DSAGSL is about and how they function.

I occasionally check in with the DSAGSL and their programs.

I know little about what the DSAGSL actually is.

I am not familiar with the DSAGSL at all.

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* 13. From what other agencies do you / the person with Down syndrome receive services and supports?'

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* 14. What are the DSAGSL's most important services, in your opinion?

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* 15. What services do you / the individual with Down syndrome need that you cannot find in your area? Please explain.

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* 16. Are DSAGSL's programs, events, and information accessible?

Yes - I feel I can participate in the services and programs I need.

No - I cannot / do not participate

If you do not participate, please explain why not

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* 17. How can DSAGSL better serve the Down syndrome community in your area?

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* 18. Can we contact you for additional details or to participate in a focus group about the DSAGSL's work?

Yes