Disability Survey - Human Services Commission June 2018

The Fairfield Human Services Commission and the Human Services Department are committed to providing all residents with access to services. If you would like assistance in completing this survey, please call 203-256-3169.  The survey is for the needs of people with disabilities in Fairfield and available for your input until Thursday, June 21, 2018.

Thank you for your valued support!
Terry Giegengack, Director, Fairfield Human Services Department

Are you a resident of the Town of Fairfield?

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* 1. Are you a resident of the Town of Fairfield?

Please describe your involvement with disability or with the disability community. Check all that apply.

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* 2. Please describe your involvement with disability or with the disability community. Check all that apply.

If you are the parent or guardian of an individual with a disability, or if you have a disability, please indicate the age range of the individual with the disability.

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* 3. If you are the parent or guardian of an individual with a disability, or if you have a disability, please indicate the age range of the individual with the disability.

If you are the parent or caregiver for an individual with a disability, or if you have a disability, please indicate if care is provided in your home.

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* 4. If you are the parent or caregiver for an individual with a disability, or if you have a disability, please indicate if care is provided in your home.

How would you describe local and regional resources and support for individuals with disabilities?

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* 5. How would you describe local and regional resources and support for individuals with disabilities?

What issue areas would be appropriate for a town disabilitiy task force? Check all that apply.

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* 6. What issue areas would be appropriate for a town disabilitiy task force? Check all that apply.

Please tell us how you learned or heard about this survey.

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* 7. Please tell us how you learned or heard about this survey.

Would you support the establishment of a town task force to identify resources and support for individuals with disabilities?

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* 8. Would you support the establishment of a town task force to identify resources and support for individuals with disabilities?

Optional: Would you like to receive information or participate in the establishment of a Fairfield Taskforce on Disabilities?

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* 9. Optional: Would you like to receive information or participate in the establishment of a Fairfield Taskforce on Disabilities?

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