Residential Interest Survey - Resident with Intellectual/Developmental Disability
This interest survey is to be completed by the person with disabilities who has an interest in potentially living at One Kin Roof. If the person with the disability needs help filling it out, a family member or other support person can help! The questions are directed at the person with disabilities, not the person helping them fill out the form. This is not an application to live at One Kin Roof, just a survey so we can have a better idea of what you would like in a housing option!
The person completing this survey is:
In what county do you currently live?
How old are you?
How would you best describe your disability? (check all that apply)
Where do you currently live?
Select your current income and public benefits:
Are you currently receiving support services through the Agency for Persons with Disabilities (APD)?
How do you best communicate?
How would you describe your support needs?
Are you employed or participate in other meaningful daily activities?
How many combined hours per week (average) do you work, volunteer and/or go to a day program?
What do you feel are the barriers to friendship and access to your community:
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This form was created inside of Madison House Autism Foundation.