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.

* 1. Gender

* 2. Age

* 3. Race/Ethnicity

* 4. Disability Type

* 5. Relationship to Participant

* 6. Household Income - Gross

* 7. Number of People in Household

* 8. Household Type

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

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