Survey - Kitsune

We endeavor to serve members of our community that tend to fall through the cracks of support services due to developmental disabilities without intellectual disabilities. Your participation in this survey will help us to determine the needs in our community and allow us to plan for support groups for the person with the disability and their family and caregivers. We will keep your personal information private. Thank you for your participation!

Person completing the survey *

First

Last

Email *

Where are you located? (Select from the drop down menu)

Your Zip Code

Your role

Parent/Family member
Caregiver
Person with the Disability

Does your family have a plan in place for caregiving as your person with disability ages and/or outlives their current caregiver?

Yes
No
Thought about it
Don't know where to start

Please provide us with your person with disability's first name, age, gender and diagnosis.( We realize that there are an array of diagnoses and we want to be sensitive to each individual's unique circumstances.) This will help us in forming support groups tailored to your family's needs.

On a scale of 1 to 10 how satisfied are you with the support system you have in place? 1 = unsatisfied, 10= very satisfied

Selected Value: 1

If you could create a system of support that met your needs, what would that look like?

Where does the person with disability live?

At Home/with family
Independently
A place with back-up support?
A hybrid of living situations

On a scale of 1 to 10, how interested would you be in attending a parent/caregiver support group? 1= not interested. 10= Very interested.

Selected Value: 1

If we were to offer educational seminars relevant to parents/caregivers, what topics areas would appeal to you?

Finances & Future Planning
Counseling
Legal Issues
Stress Management

What types of activities does your person with disabilities like to participate in? ( We would like to schedule opportunities for social engagement when it is safe to gather in person sometime in the future.)

Kitsune's long range plans include developing housing with supports for independent living. Would you be interested in following our progress on this topic?

Yes
No

How did you hear about this survey?

Additional comments or suggestions

Thank you for your participation!

Is a 501c3 educational organization, founded in 2016.