We are graduate students in the Occupational Therapy Program at Sacred Heart University. For one of our classes, we have been asked to assess the services needs for adults with disabilities aged 18+ in Fairfield, Connecticut. In conducting a survey, we hope to learn more about the needs of adults with disabilities in this area. The information you and others provide will assist us in understanding the services and supports that are needed in the community.

Your answers will remain confidential, and there is no need to indicate your name on this form. However, if you wish to reach out to us with further information, questions, or concerns, our contact is listed at the bottom of this form. We thank you in advance for your time and effort in completing this survey.

Question Title

* 1. I identify as ________.

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