Disability Rights & Resources Consumer Needs Survey

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Disability Rights & Resources seeks public input regarding the independent living needs of people with disabilities of all ages. People with disabilities, family members, advocates, professionals, and others are asked to rank priorities listed below. Information obtained from this survey will be considered in the development of our agency's workplan. E-mail questions to dan.kessler@drradvocates.org Thank you!

Housing (5=High Need) (1=Low Need)

Clear selection

Home Modifications (5=High Need) (1=Low Need)

Clear selection

Transportation (5=High Need) (1=Low Need)

Clear selection

Employment (5=High Need) (1=Low Need)

Clear selection

Healthcare (5=High Need) (1=Low Need)

Clear selection

Personal Assistance (5=High Need) (1=Low Need)

5 High

1 Low

Clear selection

Education (5=High Need) (1=Low Need)

Clear selection

Community Accessibility (5=High Need) (1=Low Need)

Alternate formats, Service Animals, Accessible business or government buildings and programs, etc

Clear selection

Provision of Sign Language Interpreters (5=High Need) (1=Low Need)

Interpreters for healthcare, employment, government services, etc.

Clear selection

Assistive Technology (5=High Need) (1=Low Need)

Clear selection

Basic Needs (5=High Need) (1=Low Need)

Food, clothing, utilities, etc.

Clear selection

Other High Need

Please List

Please identify yourself

Check one or more categories that best desribes you.

Person with a Disability

Family Member of a Person with a Disability

Advocate

Educator

Professional (Other than Educator)

Other:

Comments

Please add comments regarding those issues you ranked as high need.

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