JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
North Brunswick Township Abilities Council
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Hello! What's your name?
*
Your answer
Do you live in North Brunswick?
*
Yes
No
What is your age range?
18-28
29-39
40-49
50+
Clear selection
How do you identify?
Male
Female
Prefer not to say
Other:
Clear selection
What is your current employment status?
Student
Disabled
Unemployed
Self Employed
Employed Part Time
Employed Full Time
Retired
Other:
Clear selection
Are you familiar with the existing disability services/programs available in our town?
*
Yes
No
If yes, please specify the disability services/programs you are aware of.
Your answer
Do you believe that the current disability services/programs in our town adequately meet the needs of individuals with disabilities?
Yes
No
Clear selection
If no, please describe the specific gaps or areas where improvements are needed.
Your answer
What types of disability services/programs do you think should be prioritized or expanded in our town?
*
Your answer
How would you rate the accessibility of public buildings and infrastructure in our town for individuals with disabilities?
Poor
1
2
3
4
5
Excellent
Clear selection
What barriers or challenges do you perceive individuals with disabilities face in our town?
Your answer
Are there any specific suggestions or ideas you have to enhance disability services/programs or improve accessibility in our town?
Your answer
Would you be willing to actively participate in initiatives or volunteer your time to support the development of disability services/programs in our town?
Yes
No
Maybe
Clear selection
Is there anything else you would like to add?
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report