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Adult Services Info Gathering
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What's your name?
2
Given our current group of adult learners, we would like to offer an opportunity to come together as a group with parents and BCBAs to provide support and share resources.
Would you be interested in participating?
Yes
No
Maybe
3
If you answered maybe, what information could help you decide?
4
If you're interested, which day of the week and time of day works best for a meeting?
(choose any/all that work for you)
Mornings, 9-12
Mid-day, 12-3
Afternoons, 3-6
Evenings, 6-8
5
What are some things you would like the group to cover?
Select one or more answers
Adult Day Programs, comparing, sharing resources
Job training, placement and support
Long term care
Long term housing
Other (please describe below)
6
What are some other topics you'd like to discuss with the group?
7
How often would you be interested in meeting with the group?
Select one or more answers
Once per month
Once per quarter
Twice per year
8
Do you have any other questions, comments or interests for us to consider?
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