Thank you for participating in our survey. Your responses will help us make a plan to use the Council's money and time to benefit people with developmental disabilities and their families. Your answers will be combined with of all the of those taking the survey. Your name, location, contact information or anything that could identify you will not be attached to the answers you provide or the final results.

The survey will take approximately fifteen minutes. You do not have to answer any question you do not want to answer and you can stop the survey at any time. There are no wrong answers. We value everything you have to say.

If you have questions please contact:
Brian Dahl
brian.dahl@ddc.wa.gov
(360) 586-3555 (Office)
(253) 208-1642 (Cell)

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* 1. Please check the category that best describes you:

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* 2. What is your zip code?

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* 3. How would you describe where you live?

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* 4. What is your race and/or ethnicity?

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* 5. Please Identify three (3) things that are important to you.

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* 6. Is there anything not listed above that is important to you?

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* 7. What are the barriers to getting the things identified above?
(Check all that apply)

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* 8. Are there any barriers not listed above?

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* 9. What do you worry about or what causes you stress?
(Check all that apply)

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* 10. Are there other things not listed above that cause you to have stress or worry?

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* 11. What do you think the Council should spend its money and resources on?
(Check all that apply.)

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* 12. Is there anything not listed above that you think the Council should spend its money and resources on?

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* 13. Is there anything you want the Council to know or understand as we create our new State Plan?

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