The purpose of this survey is to gather information about the needs and concerns of families of individuals with developmental disabilities throughout New Jersey. Unfortunately, the Division of Developmental Disabilities is not collecting aggregate data about the needs of the families they serve. We are hoping that this survey will provide a snapshot of the needs of families of individuals with developmental disabilities. As the largest statewide advocacy organization for individuals with intellectual and other developmental disabilities we will use this information to help guide our advocacy agenda. We also hope that you will join our advocacy efforts by agreeing to receive email updates and action alerts from our Family Advocacy Program. Your personal information will not be shared with anyone outside of The Arc of New Jersey without your permission. Thank you for participating in this survey!

*

1. Please provide your contact information below. It will not be shared with anyone outside of The Arc of New Jersey without your permission.

Please provide your contact information below. It will not be shared with anyone outside of The Arc of New Jersey without your permission. First Name:
Last Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

*

2. Please select one of the following:

Please select one of the following: I would like to receive email updates and action alerts from The Arc of New Jersey's Family Advocacy Program.

I am not interested in receiving additional information.

*

3. What is your relationship to individuals with developmental disabilities?

What is your relationship to individuals with developmental disabilities? Parent

Sibling

Other Family Member/Guardian

Concerned Citizen