SPEAK Up & Out with KCDD Self-advocates Promoting Empowerment & Access in Kansas Question Title * 1. Contact Info Title (Mr./Mrs./Miss/Dr., or other) Full Name Title/Organizational Affiliation Address Address 2 City/Town State/Province Zip/Postal Code Country Email Address Phone Number Question Title * 2. How would you describe yourself? White/Caucasian Black Native American/Alaska Native Asian Native Hawaiian/Other Pacific Islander Hispanic or Latino Prefer not to say Other (please specify) Question Title * 3. What age range would you define yourself as? Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 4. What is your gender? Question Title * 5. I am attending this conference as a: Self-advocate Parent/guardian of a child (under 18 years old) who has a disability Immediate family/guardian of an adult who has a disability Member or employee of a local and/or non-governmental agency, or a nonprofit organization with a mission focused on serving the disability community Employed by a Kansas State Agency that provides services for children and/or adults with disabilities Caregiver or staff supporting a person with a disability Other (please specify) Question Title * 6. How did you hear about this event? Social media Email newsletter Word of mouth Advertising Other (please specify) Question Title * 7. Which breakout sessions are you interested in attending? Select all that apply. Advocacy 101 (in school, in the workplace, in the government, and in general) with a panel Legislative Advocacy (Legislative 202) How to ask for accommodations in the workplace and with your advocacy + AI to improve our lives Key Priorities across the Lifespan of the Disability Community Goal Setting Final Remarks and Panel Question Title * 8. What are your expectations for this event? Question Title * 9. We want to make sure this event is fully accessible to you. Please get in touch with lola@kcdd.org by September 15th with your requests. Dietary Restrictions Accommodations ASL Language Interpretation Other (please specify) Question Title * 10. How easy was the registration process? Very easy Somewhat easy Neutral Somewhat difficult Very difficult Scholarships and travel assistance are available upon request. Please send your request to allyson@kcdd.org by August 15th. Done
