Council Survey

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* 1. Race/Ethnicity

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* 2. Gender

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* 3. Geographic Area

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* 4. Please check the statement that best describes you.  Check one box only.

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* 5. Are you satisfied with this Workshop series?

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* 6. On a scale of 1 to 10 (10=highest), how would you rate this Training Conference in terms of usefulness and helpfulness?

1   Not at all Useful or Helpful 10   Extremely Useful or Helpful
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i We adjusted the number you entered based on the slider’s scale.
Please help us to know how your levels of independence, productivity, self-determination, integration and inclusion (ISPII*) have increased as a result of participating in this Workshop series.  Evaluate yourself on a scale of 1 (lowest) to 5 (highest) for each measure.

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* 8. Independence:  After participating in this Training Conference, I have become more independent* at work, home or school: 
*Independence means the extent to which individuals exert control and choice over their own lives.

1   Has not increased at all 5  Has increased very much
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i We adjusted the number you entered based on the slider’s scale.

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* 9. Productivity:  After participating in this Training Conference, I am more productive.*
*Productivity means starting employment or a positive change in one's employment situation (better wages, hours, benefits, improved status, or job advancement.

1   Has not increased at all 5  Has increased very much
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i We adjusted the number you entered based on the slider’s scale.

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* 10. Self Determination:  After participating in this Training Conference, my self-determination* has increased.
*Self-determination means the freedom to choose where and with whom to live or taking personal responsibility for personal decisions about needed supports and services.

1   Has not increased at all 5  Has increased very much
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i We adjusted the number you entered based on the slider’s scale.

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* 11. Integration and Inclusion:  After participating in this Training Conference, I have experienced more community integration and inclusion.*
*Integration and inclusion means using the same community resources that are available to other citizens or fully participating in community activities.

1   Has not increased at all 5  Has increased very much
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i We adjusted the number you entered based on the slider’s scale.

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* 12. If you have additional comments, please write them here.  Thank you!

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