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Adults with Disabilities, Parent & Caregiver Survey
Your feedback will help us better understand the needs, interests, and goals of adults with disabilities and their caregivers so we can develop meaningful programs, services, and opportunities.

ABOUT YOUR CHILD
1.What is the age of the adult you care for?
2.What type(s) of support needs does your adult have? (Check all that apply)
3.What is your adult's current living situation?
PROGRAM INTERESTS
4.What types of programs would you most like to see offered? (Check all that apply)
SCHEDULING & ACCESSIBILITY
5.What days work best for programs? (Select all that apply)
6.What time(s) work best for you?
7.Would transportation be helpful?
8.What barriers would make participation difficult? (Check all that apply)
CAREGIVER SUPPORT
9.What resources would you find most helpful as a caregiver? (Check all that apply)
OPEN FEEDBACK
10.What is your biggest concern about your adult's future?
11.What are your adult's greatest strengths or interests?
12.What programs or services are missing in your community?
13.If you could create the ideal program for your adult, what would it include?
14.Any additional thoughts or suggestions:
OPTIONAL INFORMATION
15.Parent/Guardian Name(S)
16.Child's Name
17.E-mail address
18.Street address
19.Would you like to be added to Full Circle Foundation's mailing list?
THANK YOU!

Your input is valuable and will help us shape the opportunities for adults with disabilities and their families.