Services for Independent Living Educational Programming Needs Assessment
1. What is your relationship to SIL?
2. Please select your age from the range below (optional)
3. I identify my gender as: (optional)
4. Please select the county in which you live from the choices below.
5. Are you aware that SIL offers educational programming?
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6. How often do you attend an SIL program?
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7. What time of day works best for you to attend a program? (check all that apply)
8. What day of the week works best for you to attend a program? (check all that apply)
9. How often do you visit our website?
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10. How often do you visit our Facebook page?
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11. What are the reasons you do not attend programming at SIL? (check all that apply)
12. What is your preferred method of attending a session?
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13. How long would you want a session to last?
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14. What general programming topics interest you (check all that apply)
15. I would be interested in programming focused on the following social skills (check all that apply):
16. I would be interested in programming focused on the following health and wellness topics (check all that apply):
17. I would be interested in programming focused on the following life skills (check all that apply):
18. What activities would you be interested in? (check all that apply):
19. Would you be interested in helping plan or lead a session?
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20. Are you comfortable with public speaking?
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21. Would you be interested in leadership training that would help prepare you to serve on a board or committee in your community?
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22. Are you aware of the support groups SIL has to offer?
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23. What support groups if any would you like to see SIL offer?
24. Would you be interested in starting a support group?
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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 ?
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If you answered yes, please provide your name and your contact information:
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