KCDD Project Participant Evaluation Template

Thank you for participating in an activity that is supported by the Kansas Council on Developmental Disabilities. In our efforts to always enhance activities we support, we would like to know more about the people who participate in Council funded projects, how those projects impact their lives, and how satisfied participants were with the activity.

Please take a moment to fill out this survey and provide us feedback so we can continue to provide quality programs designed to enhance the independence, productivity, self determination, and integration & inclusion of individuals with developmental disabilities in the communities of their choice.

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* 1. Tell us a little about yourself. Please circle what best describes you:

Person with a disability

Family member

Support Staff

Other professional

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* 2. Race/Ethnicity

White alone

Black or African American alone

American Indian or Alaska Native alone

Hispanic/Latino

Asian alone

Native Hawaiian & Other Pacific Islander alone

Two or more races

I prefer not to say

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* 3. Gender

Female

Male

Other

I prefer not to answer

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* 4. Geographic profile

I live in a town or city with 50,000 or more people

I live in a town or city with less than 50,000 people

I prefer not to answer this question

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* 5. After participating in this project, I think I can advocate more often for myself or my loved one

Yes

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* 6. After participating in this project, it is easier to tell people what is important to me or my loved one

Yes

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* 7. After this project, I plan on participating in more advocacy activities

Yes

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* 8. After participating in this project, I will serve on a cross disability coalition, policy board, advisory board, governing body and/or serve in a leadership position.

KCDD Project Participant Evaluation Template

Question Title

* 1. Tell us a little about yourself. Please circle what best describes you:

Question Title

* 2. Race/Ethnicity

Question Title

* 3. Gender

Question Title

* 4. Geographic profile

Question Title

* 5. After participating in this project, I think I can advocate more often for myself or my loved one

Question Title

* 6. After participating in this project, it is easier to tell people what is important to me or my loved one

Question Title

* 7. After this project, I plan on participating in more advocacy activities

Question Title

* 8. After participating in this project, I will serve on a cross disability coalition, policy board, advisory board, governing body and/or serve in a leadership position.

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* 9. I was satisfied with this project activity.

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* 10. Comments