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25% of survey complete.
Please take 15 minutes to complete this survey. We appreciate your time in helping us determine what resources are available and being utilized here in the Inland Empire. You will need to complete one survey for each person with a disability (so if you have two children with autism, you may complete two surveys).

* 1. Are you a

* 2. What do you consider the primary disability that you or your loved one have?

* 3. What other diagnoses that you or your loved one have?

* 4. What is the age of the person with a disability?

* 5. Which county do you live in?

* 6. Which race/ethnicity best describes the person with the disability?

* 7. What is the primary language spoken at home? (Please choose only one.)

* 8. Please check all the services the person with the disability currently has: