What would you like to learn more about from the Family Advisory Council?

Question Title

* 1. In which Ohio county do you live?

Question Title

* 2. Are you a family member of a person with a disability?

Yes

No

Question Title

* 3. Check the box that best describes your relationship with your family member(s) with a disability:

Parent

Grandparent

Sibling

Self

Other (please specify)

Question Title

* 4. In which stage of the lifespan is the person with a disability?

Infant/toddler (0-2)

Early childhood (3-5)

School age (6-14)

Transition age/young adult (14-21)

Adult (22-54)

Retirement/late in life (55+)

Other (please specify)