MCBDDS Self-Determination Satisfaction Survey 2017

Thank you for completing this survey about the Self-Determination program offered by the Montgomery County Board of Developmental Disabilities Services (MCBDDS). To ensure MCBDDS is offering quality services, it is important that the Board ask for feedback about those services from the people who receive them. We prefer that the individual who receives services respond to each question. If family/friends/providers wish to offer input or feedback, we ask that they include it at the end of the survey, and include their name and relationship to the person receiving services next to their comments.

Please Note:  If you do not currently participate in the County Board's Self-determination program, please DO NOT take this survey.

This survey will be distributed via mail and the MCBDDS website. We ask that individuals complete one OR the other, but NOT both, no later than November 29, 2017 at 11:59 p.m. The electronic survey is available at http://www.mcbdds.org/sdsurvey. To return the survey via U.S. Mail, please use the enclosed self-addressed, stamped envelope OR mail it to: MCBDDS Self-Determination Survey, 5450 Salem Avenue, Dayton, OH 45426. Should you have questions about the survey, please call 937-837-9279. 

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* 1. Name:

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* 2. Date:

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* 3. Do you like having Self-Determination as an option offered by the Board? (Please check the box that most closely represents your feelings.)

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* 4. If you like having Self-Determination as an option, please explain WHY.

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* 5. WHAT are the two (2) most important services/items you use Self-Determination for? (Please explain why.)

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* 6. Please EXPLAIN how your life is/has been impacted by Self-Determination. (Please explain.)

In the next section, please put an "X" in the box that most closely represents your feelings about each question.

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* 7. Self-Determination helps me reach my goals and outcomes more easily.

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* 8. Self-Determination helps me reach my employment goals.

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* 9. Self-Determination helps me be a better self-advocate.

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* 10. Self-Determination offers me alternatives that make my life more satisfying.

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* 11. Has Self-Determination helped you direct services/outcomes in your own life? (Please explain.)

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* 12. Is there anything about the Self-Determination process that you would like to change? (Please explain)

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* 13. If someone helped you complete this survey, please list their name and relationship to you here:

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* 14. Is there anything else you or your helper would like to share? (Please attach an additional page if necessary.)

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