Please read and answer each question carefully. Be sure to click “done” when you are finished.

If you are a family member or other advocate for someone with a disability, please answer the survey the way you think the person with the disability would answer.

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* 1. I am (please choose all that apply)

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* 4. Has COVID-19 caused problems for you? If yes, please explain what kind of problems you've had from COVID-19.

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* 5. Please select all questions, concerns, and issues about COVID-19 that apply to you:

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* 6. Choose up to 3 of your top concerns

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* 7. Is there anything else you'd like to share with us?

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* 8. Thank you for completing this survey. If you would like to be entered into a drawing to win a gift card, please enter your contact information below (Enter your name and address or your email)

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* 9. If you would like to receive DRO updates through your email, please write your email below:

Contact the Disability Rights Ohio Intake Department if you think that your legal rights have been violated because of a disability, such as being abused or neglected, discriminated against, denied services or unable to access public facilities. We may be able to help.

Call 614-466-7264 or 1-800-282-9181, press option 2, and leave a voicemail

OR

Fill out our online form at https://www.disabilityrightsohio.org/intake-form
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