This survey is for youth ages 14-24 who have a disability and/or their parent or guardian.

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* 1. Name

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* 2. If you are 18 years or older please provide your e-mail and/or phone number

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* 3. If you are under 18 years, please enter your parent or guardian's name and number.

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* 4. What is your age group?

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* 5. What county do you live in? 

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* 6. What activities do you do in your free time?

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* 7. Do you participate in programs/activities during the year?

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* 8. If yes, what kind of activities/programs have you participated in?

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* 9. If not, are there barriers that get in the way of participating (cost, transportation, etc)? 

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* 10. How aware are you of the programs offered at Access to Independence?

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* 11. Of the programs that we offer (listed below), which ones are you most likely to participate in

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* 12. What is your preferred way to communicate?

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* 13. If you're involved in a program now, what do you like most about it?

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* 14. What is the biggest barrier for you in participating in a community program not offered in your school?

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* 15. Would you like us to contact you with more information about our Youth Program?

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