2013 Spectrum Programs Survey

Please complete the survey to help SPECTRUM Autism Support Group to better plan for the future. We need your feedback to help decide the direction that the support group should go to meet the needs of the majority of the people it serves.

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* 1. What is your name?

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* 2. What is your email address?

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* 3. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 4. What is your race?

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

Other

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* 5. In what city do you live?

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* 6. What is your approximate average household income?

$0-$24,999

$25,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$124,999

$125,000-$149,999

$150,000-$174,999

$175,000-$199,999

$200,000 and up

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* 7. How old is your child with Autism?

1-4 years old

5-10 years old

11-13 years old

14-21 years old

older than 21

If you have more than one child with Autism, how old?

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* 8. How would you describe the level of autism of your child?

Severe

Moderate

Mild

Asperger's/HFA

I don't know

If you have more than one child with Autism, what level?

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* 9. Which Spectrum programs have you participated in?

	I attend/used regularly	I have attended/used rarely	I have never attended/used	I am unaware of this program
Monthly Support Meetings	Monthly Support Meetings I attend/used regularly	Monthly Support Meetings I have attended/used rarely	Monthly Support Meetings I have never attended/used	Monthly Support Meetings I am unaware of this program
Monthly Planning Meetings	Monthly Planning Meetings I attend/used regularly	Monthly Planning Meetings I have attended/used rarely	Monthly Planning Meetings I have never attended/used	Monthly Planning Meetings I am unaware of this program
Listserv	Listserv I attend/used regularly	Listserv I have attended/used rarely	Listserv I have never attended/used	Listserv I am unaware of this program
Respite	Respite I attend/used regularly	Respite I have attended/used rarely	Respite I have never attended/used	Respite I am unaware of this program
Summer Day Camp	Summer Day Camp I attend/used regularly	Summer Day Camp I have attended/used rarely	Summer Day Camp I have never attended/used	Summer Day Camp I am unaware of this program
Camp Journey Overnight Camp	Camp Journey Overnight Camp I attend/used regularly	Camp Journey Overnight Camp I have attended/used rarely	Camp Journey Overnight Camp I have never attended/used	Camp Journey Overnight Camp I am unaware of this program
Family Fishing Day	Family Fishing Day I attend/used regularly	Family Fishing Day I have attended/used rarely	Family Fishing Day I have never attended/used	Family Fishing Day I am unaware of this program
Family Gladiators Game	Family Gladiators Game I attend/used regularly	Family Gladiators Game I have attended/used rarely	Family Gladiators Game I have never attended/used	Family Gladiators Game I am unaware of this program
Family Braves Game	Family Braves Game I attend/used regularly	Family Braves Game I have attended/used rarely	Family Braves Game I have never attended/used	Family Braves Game I am unaware of this program
Family Weekend Retreat	Family Weekend Retreat I attend/used regularly	Family Weekend Retreat I have attended/used rarely	Family Weekend Retreat I have never attended/used	Family Weekend Retreat I am unaware of this program
Morning Coffee Talks	Morning Coffee Talks I attend/used regularly	Morning Coffee Talks I have attended/used rarely	Morning Coffee Talks I have never attended/used	Morning Coffee Talks I am unaware of this program
Evening Get -Togethers	Evening Get -Togethers I attend/used regularly	Evening Get -Togethers I have attended/used rarely	Evening Get -Togethers I have never attended/used	Evening Get -Togethers I am unaware of this program
Back to School Luncheon	Back to School Luncheon I attend/used regularly	Back to School Luncheon I have attended/used rarely	Back to School Luncheon I have never attended/used	Back to School Luncheon I am unaware of this program
Drama Club	Drama Club I attend/used regularly	Drama Club I have attended/used rarely	Drama Club I have never attended/used	Drama Club I am unaware of this program
Bowling Club	Bowling Club I attend/used regularly	Bowling Club I have attended/used rarely	Bowling Club I have never attended/used	Bowling Club I am unaware of this program
Friends Day	Friends Day I attend/used regularly	Friends Day I have attended/used rarely	Friends Day I have never attended/used	Friends Day I am unaware of this program
Saturday Social Skills	Saturday Social Skills I attend/used regularly	Saturday Social Skills I have attended/used rarely	Saturday Social Skills I have never attended/used	Saturday Social Skills I am unaware of this program
Special Needs Screening	Special Needs Screening I attend/used regularly	Special Needs Screening I have attended/used rarely	Special Needs Screening I have never attended/used	Special Needs Screening I am unaware of this program
Georgia Race for Autism	Georgia Race for Autism I attend/used regularly	Georgia Race for Autism I have attended/used rarely	Georgia Race for Autism I have never attended/used	Georgia Race for Autism I am unaware of this program

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* 10. What do you like or dislike about the Monthly Support Meetings? (If you do not attend, please specify why)

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* 11. What do you like or dislike about the Monthly Planning Meetings? (If you do not attend, please specify why)

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* 12. What do you like or dislike about the Listserv? (If you do not use it, please specify why)

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* 13. What do you like or dislike about the Respite Program? (If you do not attend, please specify why)

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* 14. What do you like or dislike about the Summer Day Camp? (If you do not attend, please specify why)

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* 15. What do you like or dislike about the Camp Journey Overnight Camp? (If you do not attend, please specify why)

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* 16. What do you like or dislike about the Family Fishing Day? (If you do not attend, please specify why)

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* 17. What do you like or dislike about the Family Gladiators Game? (If you do not attend, please specify why)

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* 18. What do you like or dislike about the Family Braves Game? (If you do not attend, please specify why)

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* 19. What do you like or dislike about the Family Weekend Retreat? (If you do not attend, please specify why)

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* 20. What do you like or dislike about the Morning Coffee talks? (If you do not attend, please specify why)

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* 21. What do you like or dislike about the Evening Get-Togethers? (If you do not attend, please specify why)

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* 22. What do you like or dislike about the Drama Club? (If you do not attend, please specify why)

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* 23. What do you like or dislike about the Bowling Club? (If you do not attend, please specify why)

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* 24. What do you like or dislike about the Friends Day? (If you do not attend, please specify why)

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* 25. What do you like or dislike about the Saturday Social Skills? (If you do not attend, please specify why)

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* 26. What do you like or dislike about the Special Needs Screenings? (If you do not attend, please specify why)

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* 27. What do you like or dislike about the Georgia Race for Autism? (If you do not attend, please specify why)

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* 28. Do you have any suggestions for programs/services that Spectrum does not currently offer, that you would like to attend?

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* 29. What is the most important factor used when deciding to attend a Spectrum event/program?

Cost

Location

Date

Time

Child care available

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* 30. Do you work for a company that Spectrum could ask for a donation or apply for a grant from?

Yes

I don't Know

Please specify the company name,contact, and email or website

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* 31. Are you enrolled in the Gwinnett Community Supports and Solutions (GCSS) Respite Program?

Yes

I don't Know

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* 32. Are you enrolled in the Gwinnett Community Supports and Solutions (GCSS) Respite Program and on Autism Family Support Funds?

Yes

I don't Know

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* 33. Have you received Autism Support Funds through GCSS in the past?

Yes

I don't know

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* 34. Are you aware that you can use GCSS funding sources for Spectrum programs?

Yes

I Don't Know

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* 1. What is your name?

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* 2. What is your email address?

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* 3. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 4. What is your race?

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* 5. In what city do you live?

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* 6. What is your approximate average household income?

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* 7. How old is your child with Autism?

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* 8. How would you describe the level of autism of your child?

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* 9. Which Spectrum programs have you participated in?

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* 10. What do you like or dislike about the Monthly Support Meetings? (If you do not attend, please specify why)

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* 11. What do you like or dislike about the Monthly Planning Meetings? (If you do not attend, please specify why)

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* 12. What do you like or dislike about the Listserv? (If you do not use it, please specify why)

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* 13. What do you like or dislike about the Respite Program? (If you do not attend, please specify why)

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* 14. What do you like or dislike about the Summer Day Camp? (If you do not attend, please specify why)

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* 15. What do you like or dislike about the Camp Journey Overnight Camp? (If you do not attend, please specify why)

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* 16. What do you like or dislike about the Family Fishing Day? (If you do not attend, please specify why)

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* 17. What do you like or dislike about the Family Gladiators Game? (If you do not attend, please specify why)

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* 18. What do you like or dislike about the Family Braves Game? (If you do not attend, please specify why)

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* 19. What do you like or dislike about the Family Weekend Retreat? (If you do not attend, please specify why)

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* 20. What do you like or dislike about the Morning Coffee talks? (If you do not attend, please specify why)

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* 21. What do you like or dislike about the Evening Get-Togethers? (If you do not attend, please specify why)

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* 22. What do you like or dislike about the Drama Club? (If you do not attend, please specify why)

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* 23. What do you like or dislike about the Bowling Club? (If you do not attend, please specify why)

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* 24. What do you like or dislike about the Friends Day? (If you do not attend, please specify why)

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* 25. What do you like or dislike about the Saturday Social Skills? (If you do not attend, please specify why)

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* 26. What do you like or dislike about the Special Needs Screenings? (If you do not attend, please specify why)

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* 27. What do you like or dislike about the Georgia Race for Autism? (If you do not attend, please specify why)

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* 28. Do you have any suggestions for programs/services that Spectrum does not currently offer, that you would like to attend?

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* 29. What is the most important factor used when deciding to attend a Spectrum event/program?

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* 30. Do you work for a company that Spectrum could ask for a donation or apply for a grant from?

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* 31. Are you enrolled in the Gwinnett Community Supports and Solutions (GCSS) Respite Program?

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* 32. Are you enrolled in the Gwinnett Community Supports and Solutions (GCSS) Respite Program and on Autism Family Support Funds?

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* 33. Have you received Autism Support Funds through GCSS in the past?

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* 34. Are you aware that you can use GCSS funding sources for Spectrum programs?

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* 35. Would you like to receive information about funding or ask any questions?