The purpose of this survey is to receive feedback from adults with disabilities in the region comprised of Catawba, Caldwell, Burke and Alexander counties.  For this survey, a disability is defined as an impairment caused by a physical, mental, cognitive or developmental condition that substantially limits major life activities and is verifiable or regarded as present.   Participation will give respondents an opportunity to share important feedback that covers their needs, awareness of resources, usage, perceived service gaps and hopes for the future.  The survey will be anonymous.  The resulting information will be used as part of a Community Enhancement Project for Individuals with Disabilities study which will assist leaders with information that may lead to initiatives aimed at having a positive impact on individuals with special needs in our region in the future.

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* 1. Do you live in Catawba, Caldwell, Burke or Alexander County?

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* 2. Are you receiving assistance with completing this survey?

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* 3. What is your age?  (Please type your answer.)

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* 4. What is your race?  (Please select below.)

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* 5. What City/Town/County are you a resident of?  (Please type in.)

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* 6. Are you deaf or do you have serious difficulty hearing?

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* 7. Are you blind, or do you have serious difficult seeing, even when wearing glasses?

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* 8. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

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* 9. Do you have serious difficulty walking or climbing stairs?

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* 10. Do you have difficulty dressing or bathing?

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* 11. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?

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* 12. Are there enough opportunities for recreation and socializing, near your home, to meet your needs?

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* 13. What do you like to do for fun?

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* 14. Which recreation/social opportunities do you enjoy most near your home?

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* 15. What City/County parks or facilities do you visit the most?

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* 16. What prevents you from accessing recreational opportunities in the area?

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* 17. What is the main way in which you get information on services, recreation and other opportunities specific to your needs?

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* 18. What types of support to individuals with disabilities do you believe are missing from your community or the region?

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* 19. What prevents you from accessing services and supports?

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* 20. Do you experience any transportation challenges in your area?

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* 21. Are you currently enrolled in an education program?

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* 22. What educational opportunities do you wish existed in your area?

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* 23. Have you been able to find good housing in your area?

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* 24. Are you employed?

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* 25. What types of employment do you wish existed in your area?

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* 26. Where do you see yourself in the future?  (Please check all that apply).

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* 27. What do you believe would be the best ways for local government to serve individuals with disabilities?

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* 28. What is the main way that you spend your time?  What do you do most?

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* 29. What do you wish people knew about individuals with disabilities?

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* 30. Thank you for taking the survey!  If you would like to enter a contest to win City of Hickory prizes, please contact Natalie Jackson via e-mail at njackson@hickorync.gov or by phone at 828-851-6473.

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