Jewish Community Inclusion Survey Question Title * 1. Please select the answer that best applies to you, I am a: Person with a disability Parent/guardian of child (under 21) with a disability Parent/guardian of a an adult (21 and over) with a disability Caregiver of a person with a disability (in or out of home) Caregiver of a person with a disability (not a family member) Family member of a relative with a disability Other (please specify) Question Title * 2. What is your zip code? Question Title * 3. What your age, or the age of the individual(s) in your household with a disability (select all that apply): 0 - 5 6 - 12 13 -17 18 - 24 25 - 34 35 - 44 45 - 60 61+ Question Title * 4. Please check all disabilities that apply to you or the person you are caring for: Autism Spectrum Disorder Learning Disability Developmental Disability Speech or Language Disability Hard of Hearing/Hearing Loss Deafness Blindness or low vision Mental Health Disorder Neuromuscular Disorder Neurological Disorder Other/Invisible Disability (please specify) Question Title * 5. Which Jewish agencies do you currently participate in (select all that apply)? Chabad Columbus Community Kollel CJDS CTA JCC JewishColumbus Jewish Family Services Lifetown OSU Hillel Synagogue Other (please specify) Question Title * 6. Do you feel like there are sufficient disability support resources available in the Jewish community? Yes No If your answer was no, please explain what you feel is needed: Question Title * 7. If applicable, what types of support services do you utilize in the secular community (select all that apply)? Behavioral health Recreational services Mental health services Residential services Vocational program services PT, OT, Speech Other (please specify) Question Title * 8. If applicable, how are the disability services that you utilize paid for (select all that apply)? Government funding Covered by the agency Personal funds Insurance Question Title * 9. Do you require financial assistance for disability support services? Yes No If yes, please specify which supports require financial assistance? Question Title * 10. What is your level of Jewish observance? Reconstructionist Reform Conservative Orthodox Non-affiliated Other (please specify) Question Title * 11. Are you a current member of a synagogue? Yes No If yes, please identify which synagogue you belong to) Question Title * 12. How often do you attend services or events at your synagogue (select the answer that best applies)? Daily Weekly Monthly High Holidays only Never Other (please specify) Question Title * 13. Do you feel like your synagogue provides reasonable accommodations for individuals with disabilities? Yes No If yes, please expand on your answer: Question Title * 14. Do you feel like the leadership at your congregation is willing to work with you to provide accommodations? Yes No Other (please specify) Question Title * 15. Are you a current member of the JCC? Yes No Question Title * 16. How often do you attend programming at the JCC? Daily Weekly Monthly A couple times a year Never Other (please specify) Question Title * 17. Do you feel like in the areas of programming, facilities, and/or marketing the JCC provides reasonable accommodations for individuals with disabilities? Yes No Please expand on your answer: Question Title * 18. What programming in the Jewish community are you not able to attend because of lack of accessibility when it comes to disability inclusion (select all that apply): Religious school Early childhood programs Youth programs Adult programs Senior programs None of the above Other (please specify) Question Title * 19. Is your child currently enrolled in a Jewish educational program? Yes No Question Title * 20. Are you, or the individual in your household with a disability, involved in Young JewishColumbus, or any other young adult programming? Yes No Question Title * 21. What type of program is your child enrolled in (please select all that apply)? Religious school Day school Early childhood program Other (please specify) Question Title * 22. Do you feel like your child's needs are being met at these educational programs? Yes No Other (please specify) Question Title * 23. What accommodations are in place, if any, to make sure your child is successful? Question Title * 24. Do you feel like barriers to meaningful Jewish education exist for your child? Question Title * 25. If educational workshops were being offered to support individuals with disabilities and their families through the Jewish community, what topics would you like to see presented (select all that apply)? Financial planning Employment Transition planning Assistive technology Special needs law Supporting the social and emotional needs of your child Resources to bring creative Jewish programming into your home Other (please specify) Question Title * 26. What type of general programs are of interest to your child (select all that apply)? Recreational programs Art programs Music programs Sports programs Wellness programs Social programs Support groups Jewish holiday and festive celebrations Other (please specify) Question Title * 27. What is the best time for you and your child to attend a community program (select all that apply)? Weekdays - during the day Weekdays - during the evening Weekend - during the day Weekend - during the evening Other (please specify) Question Title * 28. Are you comfortable with attending in-person programming? Yes No Other (please specify) Question Title * 29. What barriers (if any) exist that keep you from attending community programs (select all that apply)? Transportation Finances Time Accessibility Not having an interpreter present Interest Other (please specify) Question Title * 30. Please share any additional comments or feedback that you think would be helpful in making the Jewish community more inclusive: Done
