EquallyAble Disability Center Survey

EquallyAble, a nonprofit working globally since 2001, is planning to build disability centers in a number of developing nations where people with disabilities lack access to education, equipment, employment, and rehabilitative services.  These centers will bring together under one roof all the services and support necessary to empower them to lead independent, productive lives with honor and dignity.

To ensure these centers best meet the needs of people with disabilities, we would appreciate your completing the 10-question survey below.  Thank you in advance for your time. 

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* 1. Please indicate if you are:

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* 2. All remaining questions should be answered by or for the person with a disability.  You may choose more than one answer on multiple choice questions unless directed otherwise.

Please indicate the city and neighborhood in which you live.

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* 3. Please indicate your gender (M or F) and age in years.

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* 4. What type of disability do you have?

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* 5. Do you use any of the following?

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* 6. Have any of the following barriers prevented you from going to school?

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* 7. If you are unemployed and desire to work, what is preventing you from getting a job or starting your own small business?

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* 8. What type of help is most important for you personally? (please choose just one)

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* 9. In what other ways could the community in which you live be empowered to support you?

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* 10. In what other ways could could a disability support center empower you to gain an education, earn a living, and lead an independent life?

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