Main Street 2 - Adults with Disabilities Community Adult Response Question Title * 1. How old are you? Question Title * 2. Do you participate in weekly activities with other people (not including your job or school)? Which ones do you enjoy? Question Title * 3. How often do you do things with other people (not including your job or school)? 1x per week 3x per week more than 3x per week have no social opportunities Question Title * 4. Which of the following activities would you enjoy? Recreational Activities (bowling, movies, dinners with friends, etc..) Trips around the area (museums, visiting historic sites. etc...) Visiting other cities Other (please specify) Question Title * 5. Do you have a job? If so, where and how often do you work? Question Title * 6. Do you currently live independently (not with your family)? Yes No Question Title * 7. If you aren't living independently, would you like to? Yes No Question Title * 8. If you are living independently, do you have a roommate or apartment mate? Question Title * 9. Where do you currently live (which town or city)? Bethesda/Chevy Chase Rockville Gaithersburg/Germantown DC Other Other (please specify) Question Title * 10. If you were to live independently, would you want to live with other people (roommates or apartment mates)? Yes No Not sure Question Title * 11. Which of the following places would you like to live? You can choose more than one. Gaithersburg/Germantown Rockville Bethesda/Chevy Chase DC area Other Question Title * 12. If you want to live independently, which of the following supports might you need (you can choose more than one)? Some daily living supports (housework, organization, budgeting money) Some weekly living supports (weekly check in to help schedule/organize the week) Just a daily check in (text/phone call) in morning and/or evening Daily check in and minimal weekly supports Continued DDA supports (if you currently have DDA support) Specific supports I would need? Done