PADDC Satisfaction Survey - SDMPA

Supported Decision Making Pennsylvania

Please check categories below that describe identify yourself.

Note: This data is being requested by our federal funder. Please provide the information for their records. This will not impact services or trainings provided.

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1. Project Activity/Event

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2. Date

Date

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3. Please identify who you are:

Individual with a developmental disability

Family Member

Other (please specify)

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4. Please check all categories below that describe how you identify yourself.

White, alone

American Indian or Alaska Native alone

Asian alone

Black or African American alone

Hispanic/Latino

Native Hawaiian & other Pacific Islander alone

Race Unknown

Prefer not to answer

Two or more races or Self Identify

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5. What is your current gender?

Man

Woman

Non-Binary

Two Spirit (*If American Indian or Alaska Native)

Prefer not to answer.

I use a different term. (write in)

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6. Do you consider yourself to be transgender?

Yes

Prefer not to answer.

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7. Which of the following best represents how you think of yourself?

Lesbian or Gay

Straight, that is, not Gay or Lesbian

Bisexual

Two Spirit (*If American Indian or Alaska Native)

Don't know

Prefer not to answer.

I use a different term (write in)

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8. Which best describes the area you live in?

Rural

Urban

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9. Which county do you live in?

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10. I (or my family member) can speak up for myself better because of what we did today.

Yes

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11. I (or my family member) can say what I want better, or what is important to me because of what we did today?

Yes

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12. I (or my family member) take part in advocacy events.

Yes

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13. I (or my family member) take part in cross disability coalitions, policy boards, advisory boards,decision-making groups: or I am the leader of a group.

Yes

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14. I (or my family member) am satisfied with what we did today.

Yes

PADDC Satisfaction Survey - SDMPA

Supported Decision Making Pennsylvania

Question Title

* 1. Project Activity/Event

Question Title

* 2. Date

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* 3. Please identify who you are:

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* 4. Please check all categories below that describe how you identify yourself.

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* 5. What is your current gender?

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* 6. Do you consider yourself to be transgender?

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* 7. Which of the following best represents how you think of yourself?

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* 8. Which best describes the area you live in?

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* 9. Which county do you live in?

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* 10. I (or my family member) can speak up for myself better because of what we did today.

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* 11. I (or my family member) can say what I want better, or what is important to me because of what we did today?

Question Title

* 12. I (or my family member) take part in advocacy events.

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* 13. I (or my family member) take part in cross disability coalitions, policy boards, advisory boards,decision-making groups: or I am the leader of a group.

Question Title

* 14. I (or my family member) am satisfied with what we did today.

1. Project Activity/Event

2. Date

3. Please identify who you are:

4. Please check all categories below that describe how you identify yourself.

5. What is your current gender?

6. Do you consider yourself to be transgender?

7. Which of the following best represents how you think of yourself?

8. Which best describes the area you live in?

9. Which county do you live in?

10. I (or my family member) can speak up for myself better because of what we did today.

11. I (or my family member) can say what I want better, or what is important to me because of what we did today?

12. I (or my family member) take part in advocacy events.

13. I (or my family member) take part in cross disability coalitions, policy boards, advisory boards,decision-making groups: or I am the leader of a group.

14. I (or my family member) am satisfied with what we did today.