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* 1. Which National Service program are you currently serving with?
(Please read all options carefully)

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* 2. Are you a:

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* 3. What city or region is your primary service location?

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* 4. When you applied to serve in your program were you aware of the availability of reasonable accommodations?*

*Reasonable Accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.

A reasonable accommodation must be feasible or plausible for the employer and must enable the individual to perform the essential functions of a position.

Reasonable accommodation examples include auxiliary aids/services, CCTV, an amplified audio listening device, a sign language interpreter, materials on audio tape, enlarged text documents, or adjusted work schedules.

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* 5. Do you consider yourself to be a person with a disability?* 

The Americans with Disabilities Act defines disability as a physical or mental impairment that substantially limits one or more major life activities of an individual, a record of such an impairment, or being regarded as having such an impairment. For more definitions, visit: www.ada.gov

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* 6. Please check any of the following conditions that substantially limit one or more of your major life activities, if you have a record of, or are regarded as having such impairment. Definitions at:  https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

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* 7. Have you disclosed* a disability to any staff persons in your organization?

*Disclosure can happen in a number of ways, from an informal conversation to a formal, written request for an accommodation. It can happen at any time during the term of service, but it should occur as soon as a person realizes they may need an accommodation.

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* 8. If you have a disability, have you requested a reasonable accommodation for your term of service?

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* 9. If you requested a reasonable accommodation was it provided by the program?

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* 10. If provided, did the reasonable accommodation allow you to fully participate in the program?

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* 11. Are you interested in learning more about disability inclusion?

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* 12. If yes, what topics are of most interest to you?

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* 13.
Thank you for completing this survey! For more information, visit www.ada.gov (Americans with Disabilities Act website) and www.eeoc.gov (U.S. Equal Employment Opportunity Commission)

Please provide additional comments below, or contact us:
Email: serve@mt.gov     Phone: (406) 444-9077     Website: serve.mt.gov  

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