As part of a grant activity funded by Washington State Dept. of Health's Early Hearing-loss Detection, Diagnosis & Intervention (EHDDI) program, WA State Hands & Voices Board members are gathering information to identify needs of  families who have deaf, hard of hearing, deaf-blind, or deaf plus (D/HH/DB/D+) children across the state. Your participation in this brief confidential and anonymous survey will allow us to provide support and information for families and inform systems of care and education in our state. 
 
If you have questions about this survey, or wish to connect with us directly, please contact Christine Griffin at gbys@wahandsandvoices.org or (425) 268-7087 (voice/text).  For more information about Washington State Hands & Voices please visit our website www.wahandsandvoices.org
 
We greatly appreciate your time to complete this 5-10 minute survey.  Please complete by September 30, 2017.  Thank you again for participating in this important survey.
 
If you are completing this survey on paper, please send via smart phone picture or scan as attachment to:
gbys@wahandsandvoices.org
 
Or mail hard copy to:
Washington State Hands & Voices
2950 Newmarket St., Suite 101-124
Bellingham, WA  98226
Thank you!

* 1. I have a deaf, hard of hearing, deaf-blind, or deaf plus child/ren in my life because I am a (check all that apply)

* 2. My hearing status is:

* 3. I am a member of WA Hands & Voices (If you are a professional or stakeholder/community member who does not have a Deaf/HH/DB/D+ child, answer #3 and then skip to #22).

* 4. How old is your child or children who are Deaf/HH/DB/D+?

* 5. How old was your child or children when you learned he/she is Deaf/HH/DB/DP?

* 6. Rate the information and resources you received from your medical providers regarding your child/ren's hearing loss?

* 7. What grade level is your child/ren in?

* 8. What school district do you live in?

* 9. Which birth-3 and/or school program does your child/ren attend?

* 10. These are the ways our family communicates at home (check all that apply)

* 11. At school my child/ren uses the following for communication (check all that apply)

  Child 1 Child 2 Child 3
Spoken English
Other spoken language
American Sign Language (ASL)
Signing Exact English (SEE)
Combination of speech and sign language
Augmentative Communication Device
Cued Speech
Other

* 12. Which hearing technologies does your child use? (Check all that apply)

  First child Second child Third child
Hearing Aid/s
Cochlear Implant/s
BAHA or Ponto
FM system

* 13. What kinds of visual technologies does your child/ren and family use? (Check all that apply)

* 14. Does your child/ren have (check all that apply)

* 15. Rate your satisfaction with the educational services your child/ren receives

  Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied
Child 1
Child 2
Child 3

* 16. Do you know other families who have children who are Deaf/HH/DB/D+?

* 17. Has your family met a deaf adult or had a Deaf Mentor?

* 18. What types of events and supports would you and your family be interested in attending? (Check all that apply)

* 19. What days of the week and times are best for your family to attend events?

  Morning Afternoon Evening Depends
Weekend
Weekday

* 20. How far in advance would you like to know about events?

* 21. Which of the following accommodations will you need to attend a family social gathering or workshop? (Check all that apply)

* 22. Are you interested in becoming involved with WA State Hands & Voices?

* 23. On a scale from 1 (highest importance) to 6 (least importance) please rank each activity you would like our state to provide.

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