This is a survey for self-advocates and family members ONLY. If you are not a self-advocate or family member, please complete the full survey 2017-2021 State Plan Public Input.

2017-2021 State Plan Self-Advocates/Family Member(s) Input
This is a survey for people with developmental disabilities who rely on public services and their families. Your responses are confidential and will help the DD Council in developing its priorities for improving services in the CNMI over the next five (5) Years. Skip any sections or questions that do not apply to you or your family members. If you need assistance in completing this survey or have questions, please contact Lillian S. Ada (670) 664-7000/1 or email her at:

1. Please check the category that best describes you:

2. What is your age?

3. What is your gender?

4. WHICH ISLAND DO YOU LIVE? (Please mark only 1)

5. In what VILLAGE do you live?

6. I live:

7. What is your ethnicity? (Please select all that apply.)

8. I Receive other Medicaid Services

9. I, or my son or daughter is on a wait list for services.  (Example:  Housing, Head Start, NAP, etc.)

25% of survey complete.