Good Works Farm, Inc.

Help us plan our services to meet your needs!  Take this quick, 10 minute survey to help guide us as we plan.  Thank you!

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* 1. Are you the parent/guardian of an individual with a cognitive disability?

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* 2. In which Ohio county do you reside?

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* 3. Does your loved one have an Ohio Medicaid Waiver (SELF, I/O, Level One, etc)?

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* 4. If your loved one has been evaluated with the Acuity Assessment Instrument (AAI), do you know what their assigned staff intensity group is?

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* 5. When planning for your child's future, which of the following statements apply? 

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* 6. If Good Works Farm began offering a farm-based adult day program in January 2020, how interested would you be in enrolling?

1 1=low 10=high 10
i We adjusted the number you entered based on the slider’s scale.

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* 7. Would it be beneficial to you if Good Works Farm offered transportation to and from adult day services?

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* 8. Are there any other programs you would like Good Works Farm to offer? (check all that apply)

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* 9. Would you be interested in volunteering at Good Works Farm in any of the following areas?  (check all that apply)

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* 10. Would you like to be contacted regarding more information about Good Works Farm Adult Day Support or Transportation?

0 of 10 answered
 

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