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* 1. Which Day Program(s) do you attend (check all that apply)?

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* 2. How often do you have opportunities to participate in community activities regularly at Day Program?

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* 3. How often do your Day Program staff support you to participate in community activities?

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* 4. How often do you choose how often you go out in the community during Day Program?

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* 5. How often are you given opportunities to learn about new volunteer activities, internships or jobs in your community?

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* 6. Do you feel the transportation to and from your day program meets your personal needs?

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* 7. Are there new opportunities offered at the day program you attend?

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* 8. What might you suggest we consider doing at your day program to make it better?

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* 9. How often do you like the way your staff support you (i.e.eating, personal care, exercising, communication, etc)?

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* 10. If you would like a personal response to your comments, please leave your name and phone number below.

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