Question Title * 1. Name Question Title * 2. Organization Name (if applicable) Question Title * 3. Address Question Title * 4. Email Address Question Title * 5. Phone Question Title * 6. Are you answering this survey on behalf of yourself or on the behalf of an organization? SELF ORGANIZATION Question Title * 7. If you are answering on behalf of an organization, what is the name of the organization? Question Title * 8. Do you or the organization hold historic materials (collections, papers, artifacts, oral histories, etc.) about disability history in Western Pennsylvania? If yes, please answer the following questions. If no, please go to question #18. YES NO Question Title * 9. Time Period of Historic MaterialsPlease indicate the time period represented in the historic material held by you or your organization. Check all responses that apply. 1700 - 1799 1800 - 1899 1900 - 1950 1951 - 1999 2000 - 2016 Question Title * 10. Type of Historic MaterialsPlease indicate the types of historic materials held by you or your organization. Check all that apply. Personal Writings (e.g. diaries, published and unpublished works, correspondence). Materials related to the founding and operation of a residential facility or care establishment, such as constitutions, mission statements, meeting minutes, annual reports, newsletters, correspondence, photographs, and other administrative records. Materials related to the founding and operation of a community service agency or advocacy group, such as constitutions, mission statements, meeting minutes, annual reports, newsletters, correspondence, photographs, and other administrative records. Audio or visual recordings of speeches, presentations, panel discussions, trainings. Interviews with individuals, families, service workers. Legal or government documents pertaining to landmark litigation, laws, codes, allocation of resources, demographics, regulations, rules, service practices, position papers. Visual images, including photos, slides, portraiture, landscapes, and prints that depict people with disability, prominent disability leaders, and places where people with disability resided, worked, or received education or treatment. Educational material for teaching children or adults with disabilities, including primers, lesson plans, curricula, manuals, teacher writings. Artifacts of institutional life, including worker and resident uniforms and apparel, adaptive equipment, pharmaceutical containers, cribs, beds, bedding, signs, dishes and eating utensils, and therapeutic equipment such as shock therapy machines, lobotomy tools, and instructional manuals. Architectural renderings of plans for buildings, homes, workshops and institutional grounds. Admission/discharge and other recipient records prior to 1950, including data that may be subject to confidentiality rules and protocols. Other (please specify) ___________________________________________________________________ Comments Question Title * 11. Populations Represented in Historic MaterialsPlease indicate which of the following disability groups are represented in the historic materials held by you or your organization. Check all responses that apply. People with developmental or intellectual disability. People with physical disability. People with mental health disability. People with vision disability. People with hearing disability. People with speech disability. People with medical conditions that have largely been eradicated, such as polio, scarlet fever, tuberculosis. People who were incarcerated or placed in institutions by the criminal justice system. Other (Please Specify) __________________________________________________________________ Question Title * 12. Use of Historic MaterialsHave you or your organization used historic materials related to people with disabilities within the last 10 years? Check all responses that apply. As part of public education, community outreach, media relations, or advertising. Available for research purposes to researchers or the general public. Available to people doing family roots/genealogy research. As appointments that decorate organizational offices, meeting rooms, and/or hallways. As the basis for conference or panel presentations by organization's employees or service recipients. As the basis for performing arts, such as a play, musical, movie or documentary that explores the history of people with disabilities. As part of orientation for training personnel, board members, and partner agencies. As part of educational curriculum at the elementary, middle school, high school, or college/university level. None of the above. Comments Question Title * 13. Organization of Historic MaterialsPlease indicate the current manner in which the historic materials are organized. All (or nearly all) of the historic materials are in labeled folders and labeled boxes. All (or nearly all) photographs are labeled. All of the historic materials are itemized in an inventory list or finding aid (collection guide). Most of the historic materials are in labeled folders and labeled boxes. Most photographs are labeled. Most of the historic materials are itemized in an inventory list or finding aid (collection guide). Some of the historic materials are in labeled folders and labeled boxes. Some of the photographs are labeled. Some of the historic materials are itemized in an inventory list or finding aid (collection guide). Few or none of the historic materials are in labeled folders and labeled boxes. Few or none of the photographs are labeled. Few or none of the historic materials are itemized in an inventory list or finding aid (collection guide). Comments Question Title * 14. Organizational ResourcesPlease indicate the resources your organization dedicates to the preservation and use of historic materials. Please check all that apply. The organization has a library, research room, archives, museum, or other permanent space dedicated to the preservation and use of historic materials related to people with disabilities. The organization employs or contracts with professionals or uses volunteers to oversee its historic collection and/or use of historic materials. The organization has received grants or used other resources for historic preservation or history-related training, community outreach, or education. The organization does not dedicate resources for this purpose. I am not affiliated with an organization. Comments Question Title * 15. Preservation of Historic MaterialsPlease indicate the overall preservation of the historic materials owned by you or your organization. Please check all that apply. Good to excellent, with state-of-the-art protective housing (e.g. acid-free folders and acid-free boxes), proper environmental controls, and adequate security. The historic materials are generally in a condition that would keep them from being lost or seriously deteriorated in the near term. Some of the historic materials are in satisfactory condition, but a significant portion is at risk of being lost, destroyed, or compromised due to storage conditions or other circumstances. The historic materials are in a precarious condition or at immediate risk of loss or deterioration due to storage conditions or lack of planning. The condition of the historic materials is unknown. Comments Question Title * 16. May we contact you for additional information about your historic materials? YES NO Question Title * 17. Would you like to receive information about resources for preserving your historic materials or finding a repository for them? YES NO Question Title * 18. Would you like to receive eNewsletter and other information from Western Pennsylvania History and Action Consortium? YES NO Question Title * 19. Please use this box for comments, questions or additional information. Done
