Emmaus Homes Advocacy Experience Survey

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* 1. I am a/an (check all that apply):

Self-Advocate

Emmaus Homes Client

Family Member of an Emmaus Homes Client

Emmaus Homes Direct Support Professional (DSP)

Emmaus Homes Staff (Not a DSP)

Board Member

Other (please specify):

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* 2. How often have you participated in past advocacy efforts with Emmaus Homes (for example, writing to legislators, attending Disability Legislative Rights Day in Jefferson City, etc.)?

Often

Sometimes

Never

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* 3. How often have you participated in past advocacy efforts with other organizations or as an individual (writing to local/state/federal representatives, speaking at a City Council or Board of Education Meeting, writing a letter to the editor, etc.)?

Often

Sometimes

Never

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* 4. Would you ike to participate in more advocacy efforts with Emmaus Homes?

Yes

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* 5. What advocacy trainings or events might you be willing to attend? (Check all that apply)

Coffees for Change (small gatherings in local communities where we learn about advocacy and invite elected officials, on occasion, to get to know us)

Disability Rights Legislative Day at the Capitol in Jefferson City (a rally that brings together people with disabilities and those who support them from across the state)

Short trainings ONLINE to become a more effective advocate

Short trainings IN PERSON to become a more effective advocate

Other (please specify):

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* 6. I have a close relationship with one or more of my LOCAL (city/town) elected officials.

Yes

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* 7. If you answered YES to having a close relationship with one of your LOCAL elected officials, please list their names here:

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* 8. Would you be willing to connect Emmaus Advocates to this LOCAL elected official(s)?

Yes

None of the above

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* 9. I have a close relationship with one or more of my COUNTY elected officials.

Yes

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* 10. If you answered YES to having a close relationship with one of your COUNTY elected officials, please list their names here:

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* 11. Would you be willing to connect Emmaus Advocates to this COUNTY elected official(s)?

Yes

None of the above

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* 12. I have a close relationship with one or more of my STATE elected officials (State Representative or State Senator):

Yes

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* 13. If you answered YES to having a close relationship with one of your STATE elected officials, please list their names here:

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* 14. Would you be willing to connect Emmaus Advocates to this STATE elected official(s)?

Yes

None of the above

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* 15. I have a close relationship with one or more of my FEDERAL elected officials (US Senator or US House of Representatives Member).

Yes

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* 16. If you answered YES to having a close relationship with one of your FEDERAL elected officials, please list their names here:

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* 17. Would you be willing to connect Emmaus Advocates to the FEDERAL elected official(s)?

Yes

None of the above

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* 18. If there was one issue that we could support you with in terms of advocacy, what would it be?

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* 19. I use the following Social Media apps:

Twitter/X

Facebook

Instagram

TikTok

Other (please specify)

None of the above

Emmaus Homes Advocacy Experience Survey

Question Title

* 1. I am a/an (check all that apply):

Question Title

* 2. How often have you participated in past advocacy efforts with Emmaus Homes (for example, writing to legislators, attending Disability Legislative Rights Day in Jefferson City, etc.)?

Question Title

* 3. How often have you participated in past advocacy efforts with other organizations or as an individual (writing to local/state/federal representatives, speaking at a City Council or Board of Education Meeting, writing a letter to the editor, etc.)?

Question Title

* 4. Would you ike to participate in more advocacy efforts with Emmaus Homes?

Question Title

* 5. What advocacy trainings or events might you be willing to attend? (Check all that apply)

Question Title

* 6. I have a close relationship with one or more of my LOCAL (city/town) elected officials.

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* 7. If you answered YES to having a close relationship with one of your LOCAL elected officials, please list their names here:

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* 8. Would you be willing to connect Emmaus Advocates to this LOCAL elected official(s)?

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* 9. I have a close relationship with one or more of my COUNTY elected officials.

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* 10. If you answered YES to having a close relationship with one of your COUNTY elected officials, please list their names here:

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* 11. Would you be willing to connect Emmaus Advocates to this COUNTY elected official(s)?

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* 12. I have a close relationship with one or more of my STATE elected officials (State Representative or State Senator):

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* 13. If you answered YES to having a close relationship with one of your STATE elected officials, please list their names here:

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* 14. Would you be willing to connect Emmaus Advocates to this STATE elected official(s)?

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* 15. I have a close relationship with one or more of my FEDERAL elected officials (US Senator or US House of Representatives Member).

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* 16. If you answered YES to having a close relationship with one of your FEDERAL elected officials, please list their names here:

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* 17. Would you be willing to connect Emmaus Advocates to the FEDERAL elected official(s)?

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* 18. If there was one issue that we could support you with in terms of advocacy, what would it be?

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* 19. I use the following Social Media apps:

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* 20. Name (First and Last):

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* 21. Email Address: