* 1. What is your relationship to WILS?

* 2. From the list below please mark any services you believe are needed for persons with disabilities living in your community. Please mark the column that you believe best describes the service in your community.

  Available Not Available at All
I - Accessible Transportation

* 3. II - Accessible/Affordable Housing

  Available Not Available at All
Accessible Housing
Affordable Housing

* 4.  III - Transition

  Available Not Available at All
Nursing Home Transition
Preventing Unnecessary Institutionalization
Employment Services

* 5. IV - Peer Support

  Available Not Available at All
Individual
Group

* 6. V - Information and Referral

  Available Not Available at All
IL Skills Training

* 7. VII - Advocacy (Individual/System)

  Available Not Available at All
Emergency Assistance
Voting Accessibility
ADA Accessibility Compliance
MO Property Tax Rent Rebate (Circuit Breaker)
Benefits Planning Counseling

* 8. VIII - Assistive Technology

  Available Not Available at All
Adaptive Equipment
Adaptive Telephone
Adaptive Internet/Computer
Durable Medical Equipment
Communication Services, Interpreters, Braille, and other alternative formats

* 9.  IX - Independent Living Support Services

  Available Not Available at All
Personal Care Attendant Services
Ramps and Home Modifications
Youth Services
Children's Services
Recreational
Disaster Preparedness

* 10.  X - Health Care Services

  Available Not Available at All
Mental Health Services
Prescription Assistance

* 11. What other services, not listed above, do you believe are needed in your community?

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