* 1. Member contact information

* 2. Relationship to member

* 3. Please check all of the programs that the member is currently participating in. 

* 4. Please rank each program on a scale of 1-5, with 1 being very dissatisfied and 5 being very satisfied. 

  1 2 3 4 5
Adult Development Academy (ADA)
Behavior Supports
Career Solutions/Supported Employment
Tween/Teen/Adult events
Steps to Independence
Living & Learning
College Connections
Summer Educational Enrichment SEE) Respite
School-age (Saturday bi-monthly class)
Early Education class
First Steps
Indiana Group Speech Program

* 5. How long have you, the member and/or family been receiving services and/or participating in programming at DSL? 

* 6. How frequently do you, the member and/or family members participate in programming at DSL?

* 7. How would you rate your overall satisfaction with Down Syndrome of Louisville?

* 8. How satisfied are you, the member and/or family with staff support?

* 9. Do you or your family have suggestions for improving future events, activities or programs? 

* 10. Please rate our staff on the following attributes, 5 being very good and 1 being very poor.

* 11. Please rate on a scale of 1-5, with 5 being very satisfied and 1 being very dissatisfied, your level of satisfaction with the following attributes of services and programming.

* 12. Please indicate which waiver or waiting list the member has or is on.