Center4SpecialNeeds Parent Survey
Please provide input on your needs as a parent of a young adult affected by a developmental disability. We will use your response to better serve the community through our programs and through referrals to other organizations. Thank you!
* Required
Parent's Name:
Your answer
Age of your young adult:
*
18-21
22-30
30-45
What school / work is your young adult currently in? (Check all that apply):
College
Job Training
Part-Time Work
Full-Time Work
Volunteer Work
Other:
Which C4SN programs has your young adult participated in? (Check all those that apply):
*
Free Consultation (with Gina Peters)
Young Adult Social Club
YASC - Creative Expressions
Volunteer Program
YA Mentor Program
Work It Out! Program
Educational Workshop(s)
None of the above
Other:
Required
How could C4SN programs better support you and your young adult?
Your answer
Which programs for your young adult would you like to see offered by C4SN? (Check all that apply):
*
Computer Skills Training
Life Coaching / Individual Support
Social Skills Training
More Young Adult Social Club events
Meditation / Mindfulness Classes
Yoga Classes
Other:
Required
Do you have any suggestions for future C4SN programs?
Your answer
Which services are you & your young adult interested in? (Check all that apply):
*
Regional Center
Department of Rehabilitation
Disabled Student Centers (College)
Social Security / SSI
Supplemental Nutrition Assistance Program (SNAP) Benefits
Residential Services
Health/Medical Services
Transportation / Travel Training
Social Activities
Other:
Required
Is your young adult interested in volunteering at Center4SpecialNeeds?
*
Yes
No
Other:
Do you have any other comments you'd like to share?
*
Your answer
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