Maine's Statewide Independent Living Council

Thank you for offering to complete the Maine Statewide Independent Living Council (Maine SILC) survey on Independent Living in Maine. This survey is very important information for Maine SILC as we work on theĀ 2017-2019 State Plan for Independent Living (SPIL) and beyond.

Your answers are key to us as we try to plan how Maine people can become more independent. If you need any help and support in completing this survey, simply contact Maine SILC at 207-329-6148 or email during regular work days.

* 1. Please check the one item that best describes your housing situation.

* 2. Please indicate the nature of your disability (Check all that apply):

* 3. What services do you currently receive? Check all that apply.

* 4. What services would you like to receive?  Check all that apply.

* 5. Do you currently receive or want to receive any of the additional following services?  Check all that apply.

* 6. Are you on a waiting list to get any services that you have asked about and qualified for? If Yes, please list the service(s).

* 7. Do you have difficulty with mobility in your home or getting around your community? Select one.

* 8. Do you need telephone services?  Check all that apply.

* 9. Computers and the Internet are often today’s quickest and most preferred communication and learning tools for many people and organizations.  Which statement best describes your present situation?  Check all that apply.

* 10. What other (if any) assistive devices do you need?