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The Kansas SILC wants to hear directly from people with disabilities, their family members, caregivers and other stakeholders.

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* 1. Please provide the County you reside in.

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* 2. Please Check all that apply.

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* 3. Have you contacted a Center for Independent Living for information, assistance, or service during the past 12 months?

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* 4. The next two questions ask about any services you have needed over the last 12 months and if you actually received them.  For this question, please check to indicate whether you have  NEEDED any of the following services in the last 12 months.  (please check all that apply)

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* 5. Now , please check to indicate you actually RECEIVED any of the following services in the last 12 months.  (please check all that apply)

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* 6. Please Respond to the following questions regarding COVID-19.

  Yes No
I was able to access necessary health services during the pandemic
I am interested in receiving the COVID-19 vaccination
I was able to access and receive the COVID-19 vaccination
I need help accessing the COVID-19 vaccination
I chose not to , or have been advised not to get the COVID-19 vaccination

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* 7. What barriers make it difficult for you to get the services you need to live more independently? (Check all that apply)

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* 8. What barriers prevent you from living more independently and fully participating in events and activities in your community? (Check all that apply)

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* 9. How important do you think the following are for people who have disabilities living in Kansas.  Please check the one response per topic, which best reflects what you believe. 

  Not Important Important Very Important
Advocacy/Self Advocacy 
Assistive Technology
Mental Health Services
Work Incentive Counseling 
Emergency Preparedness
Employment/Vocational Services
Access to Healthcare
Home Modifications
Housing Assistance
Independent Living Skills Training
Information and Referral Services
ASL Interpreter Services
Long Term Care Transition (Help moving back into the community)
Long Term Care Diversion ( Help to continue living in the community rather than in a facility)
Peer Support
Personal Assistance Services/Home Care
Training for managing Personal Care Services
Transportation
Disability Rights/Law Services
Computer Training
Durable Medical Equipment (help obtaining or repairing)
Social/Recreation
Youth Transition Services
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