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Community Survey
1.
How familiar are you with the programs and services provided by Wyandot County Developmental Disabilities/Angeline?
Extremely familiar
Very familiar
Somewhat familiar
Not so familiar
Not at all familiar
Please explain.
2.
Which of the following programs or services would you like to know more about? (check all that apply)
SSA/Case Management Services
Early Intervention/PLAY Project
Family Support Services
Angeline Pre-School
Angeline School-to-Adult Life Transition (SALT) /Project LIFE Program
Angeline Industries/Adult Services
Medicaid Waiver Home & Community-Based Services (HCBS)/Supported Living
Other (please specify)
3.
How satisfied are you that the programs and services of Wyandot County DD/Angeline meet the needs of local citizens with developmental disabilities and their families?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Please explain.
4.
Please tell us how Wyandot County DD/Angeline can better meet the needs of Wyandot County citizens with developmental disabilities and their families.
5.
Are there any other comments you wish to share?
6.
Thank you. Your input is important to us. Your contact information is optional and confidential. If you requested information about our programs and services, please provide your contact information below so we may follow-up.
Name
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Phone Number
Current Progress,
0 of 6 answered
