Participant Data

Thank you for taking the time to fill out this survey. Your answers help us to better serve the community and leverage important funding for our services. Please fill out this survey from the perspective of the participant. All information is anonymous and confidential. If you are filling out this survey for more than one person, please fill out a separate demographic survey for each individual that experiences I/DD.

Gender

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* 1. Gender

Age

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* 2. Age

Race/Ethnicity

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* 3. Race/Ethnicity

Disability Type

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* 4. Disability Type

Relationship to Participant

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* 5. Relationship to Participant

Household Income - Gross

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* 6. Household Income - Gross

Number of People in Household

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* 7. Number of People in Household

Household Type

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* 8. Household Type

Other services being received or accessed by person using services

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* 9. Other services being received or accessed by person using services

What are your greatest barriers in the community?

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* 10. What are your greatest barriers in the community?

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