Services for Independent Living Educational Programming Needs Assessment

1. What is your relationship to SIL?

Currently or have received services from us in the past

Parent

Case Manager/Service Provider

Other:

2. Please select your age from the range below (optional)

Under 18

18-24

25-34

35-44

45-54

55-64

65 and over

Prefer not to say

3. I identify my gender as: (optional)

4. Please select the county in which you live from the choices below.

Audrain

Boone

Callaway

Cooper

Howard

Montgomery

Randolph

Prefer not to say

Other:

5. Are you aware that SIL offers educational programming?

Yes

Clear selection

6. How often do you attend an SIL program?

More than once month

Once a month

5-8 times per year

1-2 times per year

Never

Clear selection

7. What time of day works best for you to attend a program? (check all that apply)

Morning (8 a.m.-12 p.m.)

Lunch Time (12 p.m.-1 p.m.)

Afternoon (1 p.m.-5 p.m.)

Evening (after 5 p.m.)

8. What day of the week works best for you to attend a program? (check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

9. How often do you visit our website?

Often (weekly)

Sometimes (1-3 times a month)

Rarely (less than once a month)

Never

Clear selection

10. How often do you visit our Facebook page?

Often (weekly)

Sometimes (1-3 times a month)

Rarely (less than once a month)

Never

Clear selection

11. What are the reasons you do not attend programming at SIL? (check all that apply)

I am not aware of what is offered

I do not have transportation

The time programming is offered does not work with my schedule

I do not have a computer, tablet, or smartphone to access sessions online

I do not have a stable internet connection

I prefer meeting with someone one on one instead of in a group

The topics do not interest me

I prefer meeting in person

Other:

12. What is your preferred method of attending a session?

In person

Online (Via Zoom, Facebook, Google Hangouts, etc.)

Facetime

Pre-Recorded

Other

Clear selection

13. How long would you want a session to last?

30 minutes

45 minutes

1 hour

1.5 hours

2 hours

Clear selection

14. What general programming topics interest you (check all that apply)

Healthy Relationships

Sex Education

Self Advocacy

Personal Finances

Career Exploration/Work Readiness

Emergency Preparedness

Other:

15. I would be interested in programming focused on the following social skills (check all that apply):

Good Communication (listening, eye contact, body language, assertiveness, etc)

Problem Solving

Conflict Resolution

Teamwork

Conversation Skills

Good Manners

Projecting Self-Confidence

Other:

16. I would be interested in programming focused on the following health and wellness topics (check all that apply):

Healthy Eating

Exercise

Communicating with Your Doctor

Managing Medications

Stress Management

Self-Care

Self-Esteem

Other:

17. I would be interested in programming focused on the following life skills (check all that apply):

Grooming/Personal Hygeine

Cooking/Food Preparation

Household Management (shopping, laundry, managing a personal care/attendant aide, etc)

Home Safety

How to use the Transit System

How to Use Technology

Finding Resources in the Community

Renting an Apartment/Buying a Home

Advance Directives

Retirement Planning

Setting and Achieving Goals

GED Preparation

Other:

18. What activities would you be interested in? (check all that apply):

Book Club

Blog Club

Art Classes (creating a vision board, scrapbooking, painting, etc)

Creative Writing/Journaling Classes

Theater

Dance

Fashion Show

Other:

19. Would you be interested in helping plan or lead a session?

Yes

Maybe

Clear selection

20. Are you comfortable with public speaking?

Yes

Maybe

Clear selection

21. Would you be interested in leadership training that would help prepare you to serve on a board or committee in your community?

Yes

Maybe

Clear selection

22. Are you aware of the support groups SIL has to offer?

Yes

Clear selection

23. What support groups if any would you like to see SIL offer?

24. Would you be interested in starting a support group?

Yes

Maybe

Clear selection

25. What is the biggest challenge you are facing right now?

26. Additional suggestions or comments regarding educational programming:

27. How else can SIL assist you?

Thank you for taking the time to provide your valuable feedback. Do you wish for a staff member to follow up with you regarding this survey or to be included in the drawing ?

Yes

Clear selection

If you answered yes, please provide your name and your contact information:

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