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 individuals living in the same home as the person with Down syndrome and their relationship. (If person with Ds lives in group setting, please just 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?

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

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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?

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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?

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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?

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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?

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