Persons Supported and Family Quality and Innovations Survey Summer 2024

Section 1: Demographics and Service Usage

Question Title

1. Are you a person receiving services from Empower Simcoe or a Family Member? (Required.)

Person Receiving Services

Family Member

Question Title

2. What program do you receive services from (select all that apply) (Required.)

Infant and Child Development Program

Family Support

Family Home

EarlyON Child and Family Services

Youth Programs

Housing First Program

Accommodations (Group Living)

Supported Independent Living (SIL)

Employment

Transitions

Respite Services

Community Support Services (Day Services)

Question Title

3. Which category includes your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

4. What is your gender?

Female

Male

Non-binary

Prefer not to disclose

Other (please specify)

Persons Supported and Family Quality and Innovations Survey Summer 2024

Section 1: Demographics and Service Usage

Question Title

* 1. Are you a person receiving services from Empower Simcoe or a Family Member? (Required.)

Question Title

* 2. What program do you receive services from (select all that apply) (Required.)

Question Title

* 3. Which category includes your age?

Question Title

* 4. What is your gender?

1. Are you a person receiving services from Empower Simcoe or a Family Member? (Required.)

2. What program do you receive services from (select all that apply) (Required.)

3. Which category includes your age?

4. What is your gender?