Thank you for completing the DSAGSL Census Survey. Just one person from each household needs to complete this survey and can add information for every member of their household.

DSAGSL is committed to being an inclusive community that serves all individuals with Down syndrome and their families. The information collected through the Census Survey will help DSAGSL update the membership database and better serve the Down syndrome community by securing additional grant funding, targeting communications, and identifying unmet needs.

All information collected is kept private and secure.

DSAGSL may contact you by phone to gather additional needed information.

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* 1. First and last name of person with Down syndrome:

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* 2. Please list the Parent(s) / Caregiver(s) of the person with Down syndrome and their relationship. *If person with Down syndrome lives in group setting, please list the parents/caregivers as well as indicate with what agency the person receives residential services.

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* 3. Mailing address for the individual with Down syndrome

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* 4. In what county is the household?

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* 5. Email address where your family can receive DSAGSL updates, resources, and information:

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* 6. Best phone number for your family:

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* 7. Date of birth of the individual with Down syndrome (DD/MM/YYYY):

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* 8. How does the person with Down syndrome identify?

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* 9. Is the person with Down syndrome Hispanic / Latinx / of Spanish origin?

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* 10. Gender of the person with Down syndrome

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* 11. What is the primary language used by the household?

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* 12. How do you like to receive communications from the DSAGSL? Check all that apply.

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* 13. Is there anything else you'd like the DSAGSL to know or additional areas where we can serve, support, and celebrate you and your loved one with Down syndrome?

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