SCPC Annual Survey 2014

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* 1. Please select all that apply to the person completing this survey:

I am a parent.

I am a family member.

I am a self-advocate (person with an intellectual/developmental disability).

I am a professional.

Other (please specify)

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* 2. What is the age of your family member(s) with an intellectual/developmental disability or yourself if you are a self-advocate? (You may select all that apply if answering for more than one family member.)

Infant – 3 years old (Birth to Three)

4-5 (Early Learning)

6-15 (School Age)

16-21 (Transition Age)

21-30 (Adult)

40+ (Adult)

Comments:

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* 3. Do you subscribe to the Advocacy and Family Support Newsletter?

Yes

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* 4. Did you attend any SCPC workshops in 2013?

Yes

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* 5. How useful was the information you received from the SCPC?

Very Useful

Somewhat Useful

Not Useful

Comments:

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* 6. Did the information help you to understand systems and/or services available to your family?

Yes

Comments:

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* 7. Did you call the SCPC in 2013 with questions or concerns?

Yes

Comments:

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* 8. To what extent have you shared the information you received from the SCPC?

To a great extent

To some extent

Not at all

Comments:

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* 9. The SCPC Team was available to answer questions?

Yes

N/A

Comments:

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* 10. Which of the following concerns is important to you?

Transitioning from Birth to Three/Early Intervention

Transitioning from High School to adult life

Guardianship and/or alternatives

Special Needs Trust – Financial Planning

Applying for services –Developmental Disabilities Administration (DDA), Division of Vocational Rehabilitation (DVR), Social Security, Medicaid)

Legislative advocacy

Abuse & exploitation

Special Education - Individual Education Program (IEP), Inclusion)

Respite/Medicaid Personal Care (MPC)

No Paid Services (NPS)- people who qualify for, but do not receive any paid services

Transportation

Mental Health

Non-eligibility needs – needs for people who don’t qualify for DDA

Other (please specify)

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* 11. Check all that apply

I am registered to vote

I vote

I know what district I live in

I know who my elected officials are (local, state, federal)

I have communicated with my elected officials

I would like to be involved in SCPC’s legislative advocacy efforts

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* 12. I would like to help the SCPC communicate with elected officials about the issues that affect our family. (Please include your contact information in the last question if you wish to be contacted. Otherwise skip to the next question.)

I would like to learn more about the Spokane County Parent Coalition.

I can write letters and make phone calls to our elected officials.

I would like to go to Olympia during Advocacy Days to meet my Legislator(s) and possibly testify at a Committee Hearing.

I can volunteer at the Annual Legislative Forum (specify your preference for how below)

I can volunteer throughout the year with . . .(tell us how you would most like to be involved)

I might be willing to share our story publicly. (Public Meeting, Letter, Newsletter, Testimony in Olympia, etc.)

Other (please specify)

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* 13. I would like more information about . . .(Be sure to include your contact information in the last question):

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* 14. OPTIONAL – Please complete if you want us to contact you to volunteer or follow-up with you about a concern or issue. (name, address, phone, email)