Part 1- For Adults with an FASD (IQ above 70)

 
 50% of survey complete.

FASD Communities is a national movement that has been meeting since October of 2010. FASD Communities is interested in providing housing and job opportunities for adults with FASD, who typically "fall through the cracks", unable to access appropriate supports. We hope to develop multiple properties with job/business opportunities over the next decade.

This is a two part needs assessment survey. Please provide additional information in the text boxes to help us as we move forward with planning.

Part 1- Regarding the Individual with an FASD (to be answered by parent/caregiver)

What is the sex of the individual with an FASD?

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* 1. What is the sex of the individual with an FASD?

What is the age of the individual with an FASD?

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* 2. What is the age of the individual with an FASD?

What is the current living situation for the individual with an FASD?

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* 3. What is the current living situation for the individual with an FASD?

Would the individual with an FASD be interested in an FASD Communities home with potential jobs available?

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* 4. Would the individual with an FASD be interested in an FASD Communities home with potential jobs available?

Would the individual with an FASD be willing to work to pay rent for the housing?

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* 5. Would the individual with an FASD be willing to work to pay rent for the housing?

When might the individual with an FASD be interested in moving into an FASD Communities property?

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* 6. When might the individual with an FASD be interested in moving into an FASD Communities property?

Some properties will be gender specific, and others might eventually house both males and females. We would consider: (Check all that apply)

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* 7. Some properties will be gender specific, and others might eventually house both males and females. We would consider: (Check all that apply)

When might the individual with an FASD be interested in job opportunities available through FASD Communities collaborations/businesses?

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* 8. When might the individual with an FASD be interested in job opportunities available through FASD Communities collaborations/businesses?

What is the most desired location for housing for the individual with an FASD?

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* 9. What is the most desired location for housing for the individual with an FASD?

How far away from home/family is individual with an FASD willing to live?

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* 10. How far away from home/family is individual with an FASD willing to live?

Income and county eligibility for services (check all that apply):

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* 11. Income and county eligibility for services (check all that apply):

What is the individual's highest level of education?

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* 12. What is the individual's highest level of education?

What is the individual's relationship status (check all that apply)?

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* 13. What is the individual's relationship status (check all that apply)?

Please click all that apply to the individual with an FASD:

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* 14. Please click all that apply to the individual with an FASD:

Does the individual have any medical needs?

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* 15. Does the individual have any medical needs?

Transportation

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* 16. Transportation

Does the individual have a cell phone or computer/laptop?

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* 17. Does the individual have a cell phone or computer/laptop?

List previous jobs or volunteer experience the individual with an FASD has had:

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* 18. List previous jobs or volunteer experience the individual with an FASD has had:

What types of jobs is he or she interested in (please list 2-3)?

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* 19. What types of jobs is he or she interested in (please list 2-3)?

What are the individual's hobbies or leisure activities?

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* 20. What are the individual's hobbies or leisure activities?

Click the following that apply:

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* 21. Click the following that apply:

Does the individual attend meetings? (AA, NA, or other)

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* 22. Does the individual attend meetings? (AA, NA, or other)

This survey was completed by:

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* 23. This survey was completed by:

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