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Independent Living Survey
Take the Independent Living Survey for Dynamic Independence below. Your feedback lets us know what is important to you and what services you would like to see from our Center for Independent Living.
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* Indicates required question
Please check the boxes next to the type of
help or information
that you are interested in receiving. Please provide either a phone number or address if you would like us to contact you.
ADA, Fair Housing, Service Animals, Voting Rights
Advocating for Myself
Affordable and Accessible Housing
Benefits Check-up, including: Food Stamps, Medicaid, Medicare, SSI, SSDI, Utility Assistance, Veterans Administration
Emergency Management
Employment
Equipment
Health Care, including: Medication, Copays, Health Maintenance (such as exercise programs and chronic disease self-managment)
High School Transition
Higher Education (Technical School, College, etc.)
Home Modifications
Personal Care and In-Home Support
Transition From a Nursing Home
Transportation, including: Accessible Fixed Route, Paratransit, Taxi Cabs
Other:
Name:
*
Your answer
If you would like to be contacted about information you selected, please choose the best way for us to reach you.
Phone
Email
Mail
I Prefer Not to Be Contacted
Clear selection
E-Mail Address:
Your answer
Phone Number:
Your answer
Address:
Your answer
City, ZIP
Your answer
County:
*
Craig
Nowata
Washington
Other:
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