As part of the Elmira District Community Living strategic plan to transform day supports, we are seeking input from potential, future participants who live within our catchment area. We would appreciate your feedback. No identifiable information will be shared with us unless you choose to provide us with your contact information at the end of the survey.

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* 1. What is your age range?

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* 2. Are you currently receiving services from a developmental service organization?

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* 3. Would you attend activities held in a day program setting for people with disabilities?

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* 4. If interested in attending a day program; how many days a week would you attend?

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* 5. If you are interested in attending a day programming what activities would you like to participate in?  e.g. music therapy, art/crafts, drumming

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* 6. How many people would you be comfortable being with in a building?

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* 7. Would you participate in activities that occur in the evenings and/or weekends?

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* 8. What does being involved in the community look like to you?  E.g. recreation, volunteering, employment, to be with peers, etc.

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* 9. What personal needs do you need assistance with?  E.g. insulin, tube feeding, lifts/transfers

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* 10. Are there any barriers which would prevent you from participating in activities offered in Elmira? If so, what are they?  E.g. transportation 

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* 11. Additional comments or suggestions

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* 12. Name and Contact Information (Optional)

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