I have Down syndrome.

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* 1. I have Down syndrome.

If you answered “Yes,” please go to the bottom of the page and click "Next."
The rest the questions on this page for people who are completing this survey about an adult with Down syndrome without him or her present.

If you are an adult with Down syndrome, please go to the bottom of the page and click "Next."
I am a _________ filling out this survey about an adult with Down syndrome WITHOUT him or her present.

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* 2. I am a _________ filling out this survey about an adult with Down syndrome WITHOUT him or her present.

Name (of person filling out survey about an adult with Down syndrome):

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* 3. Name (of person filling out survey about an adult with Down syndrome):

Organization:

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* 4. Organization:

Street Address:

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* 5. Street Address:

City:

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* 6. City:

State:

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* 7. State:

Zip Code:

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* 8. Zip Code:

Email Address:

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* 9. Email Address:

Phone Number:

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* 10. Phone Number:

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