NYSILC Needs Assessment Consumer Survey

	Readily Available	Somewhat Available	Not Available	N/A
Advocacy	Advocacy Readily Available	Advocacy Somewhat Available	Advocacy Not Available	Advocacy N/A
Assistive devices training	Assistive devices training Readily Available	Assistive devices training Somewhat Available	Assistive devices training Not Available	Assistive devices training N/A
Benefits Assistance and Advice	Benefits Assistance and Advice Readily Available	Benefits Assistance and Advice Somewhat Available	Benefits Assistance and Advice Not Available	Benefits Assistance and Advice N/A
Education services	Education services Readily Available	Education services Somewhat Available	Education services Not Available	Education services N/A
Employment / work readiness services	Employment / work readiness services Readily Available	Employment / work readiness services Somewhat Available	Employment / work readiness services Not Available	Employment / work readiness services N/A
Family services	Family services Readily Available	Family services Somewhat Available	Family services Not Available	Family services N/A
Home care / personal assistance services	Home care / personal assistance services Readily Available	Home care / personal assistance services Somewhat Available	Home care / personal assistance services Not Available	Home care / personal assistance services N/A
Housing services	Housing services Readily Available	Housing services Somewhat Available	Housing services Not Available	Housing services N/A
Independent living skills training	Independent living skills training Readily Available	Independent living skills training Somewhat Available	Independent living skills training Not Available	Independent living skills training N/A
Information and referral to other services	Information and referral to other services Readily Available	Information and referral to other services Somewhat Available	Information and referral to other services Not Available	Information and referral to other services N/A
Medical / health services	Medical / health services Readily Available	Medical / health services Somewhat Available	Medical / health services Not Available	Medical / health services N/A
Mobility services	Mobility services Readily Available	Mobility services Somewhat Available	Mobility services Not Available	Mobility services N/A
Peer counseling	Peer counseling Readily Available	Peer counseling Somewhat Available	Peer counseling Not Available	Peer counseling N/A
Recreation services	Recreation services Readily Available	Recreation services Somewhat Available	Recreation services Not Available	Recreation services N/A
Transportation	Transportation Readily Available	Transportation Somewhat Available	Transportation Not Available	Transportation N/A

Readily Available

Somewhat Available

Not Available

N/A

Advocacy

Advocacy Readily Available

Advocacy Somewhat Available

Advocacy Not Available

Advocacy N/A

Assistive devices training

Assistive devices training Readily Available

Assistive devices training Somewhat Available

Assistive devices training Not Available

Assistive devices training N/A

Benefits Assistance and Advice

Benefits Assistance and Advice Readily Available

Benefits Assistance and Advice Somewhat Available

Benefits Assistance and Advice Not Available

Benefits Assistance and Advice N/A

Education services

Education services Readily Available

Education services Somewhat Available

Education services Not Available

Education services N/A

Employment / work readiness services

Employment / work readiness services Readily Available

Employment / work readiness services Somewhat Available

Employment / work readiness services Not Available

Employment / work readiness services N/A

Family services

Family services Readily Available

Family services Somewhat Available

Family services Not Available

Family services N/A

Home care / personal assistance services

Home care / personal assistance services Readily Available

Home care / personal assistance services Somewhat Available

Home care / personal assistance services Not Available

Home care / personal assistance services N/A

Housing services

Housing services Readily Available

Housing services Somewhat Available

Housing services Not Available

Housing services N/A

Independent living skills training

Independent living skills training Readily Available

Independent living skills training Somewhat Available

Independent living skills training Not Available

Independent living skills training N/A

Information and referral to other services

Information and referral to other services Readily Available

Information and referral to other services Somewhat Available

Information and referral to other services Not Available

Information and referral to other services N/A

Medical / health services

Medical / health services Readily Available

Medical / health services Somewhat Available

Medical / health services Not Available

Medical / health services N/A

Mobility services

Mobility services Readily Available

Mobility services Somewhat Available

Mobility services Not Available

Mobility services N/A

Peer counseling

Peer counseling Readily Available

Peer counseling Somewhat Available

Peer counseling Not Available

Peer counseling N/A

Recreation services

Recreation services Readily Available

Recreation services Somewhat Available

Recreation services Not Available

Recreation services N/A

Transportation

Transportation Readily Available

Transportation Somewhat Available

Transportation Not Available

Transportation N/A

	1. Most Important	2.	3.	4.	5.	6. Least Important	N/A
Expand services	Expand services 1. Most Important	Expand services 2.	Expand services 3.	Expand services 4.	Expand services 5.	Expand services 6. Least Important	Expand services N/A
Expand hours of operation (nights and weekends)	Expand hours of operation (nights and weekends) 1. Most Important	Expand hours of operation (nights and weekends) 2.	Expand hours of operation (nights and weekends) 3.	Expand hours of operation (nights and weekends) 4.	Expand hours of operation (nights and weekends) 5.	Expand hours of operation (nights and weekends) 6. Least Important	Expand hours of operation (nights and weekends) N/A
Hire additional staff	Hire additional staff 1. Most Important	Hire additional staff 2.	Hire additional staff 3.	Hire additional staff 4.	Hire additional staff 5.	Hire additional staff 6. Least Important	Hire additional staff N/A
Advertise existing services	Advertise existing services 1. Most Important	Advertise existing services 2.	Advertise existing services 3.	Advertise existing services 4.	Advertise existing services 5.	Advertise existing services 6. Least Important	Advertise existing services N/A
Make home visits	Make home visits 1. Most Important	Make home visits 2.	Make home visits 3.	Make home visits 4.	Make home visits 5.	Make home visits 6. Least Important	Make home visits N/A
Expand transportation to / from the center	Expand transportation to / from the center 1. Most Important	Expand transportation to / from the center 2.	Expand transportation to / from the center 3.	Expand transportation to / from the center 4.	Expand transportation to / from the center 5.	Expand transportation to / from the center 6. Least Important	Expand transportation to / from the center N/A

1. Most Important

6. Least Important

N/A

Expand services

Expand services 1. Most Important

Expand services 2.

Expand services 3.

Expand services 4.

Expand services 5.

Expand services 6. Least Important

Expand services N/A

Expand hours of operation (nights and weekends)

Expand hours of operation (nights and weekends) 1. Most Important

Expand hours of operation (nights and weekends) 2.

Expand hours of operation (nights and weekends) 3.

Expand hours of operation (nights and weekends) 4.

Expand hours of operation (nights and weekends) 5.

Expand hours of operation (nights and weekends) 6. Least Important

Expand hours of operation (nights and weekends) N/A

Hire additional staff

Hire additional staff 1. Most Important

Hire additional staff 2.

Hire additional staff 3.

Hire additional staff 4.

Hire additional staff 5.

Hire additional staff 6. Least Important

Hire additional staff N/A

Advertise existing services

Advertise existing services 1. Most Important

Advertise existing services 2.

Advertise existing services 3.

Advertise existing services 4.

Advertise existing services 5.

Advertise existing services 6. Least Important

Advertise existing services N/A

Make home visits

Make home visits 1. Most Important

Make home visits 2.

Make home visits 3.

Make home visits 4.

Make home visits 5.

Make home visits 6. Least Important

Make home visits N/A

Expand transportation to / from the center

Expand transportation to / from the center 1. Most Important

Expand transportation to / from the center 2.

Expand transportation to / from the center 3.

Expand transportation to / from the center 4.

Expand transportation to / from the center 5.

Expand transportation to / from the center 6. Least Important

Expand transportation to / from the center N/A

Question Title

* 5. How else could your local Independent Living Center make it easier for you to access services? Please describe below.

Question Title

* 6. Where else do you go to receive services or support that help you live independently?

Check all that apply.

School

Hospital

Place of worship

Community center

Counseling/Therapy

Place of employment

Social services

Park or gymnasium

College or university

Internet resources

Group meetings

Physical therapy

Other disability agencies

Other (please specify)

Question Title

* 7. If you have problems with service agencies, how often are you able to resolve them? Check one box.

Never

Sometimes

Most of the time

Always

Not applicable

Question Title

* 8. Please check one answer for your age range.

Under 6 years old

6-17 years old

18-22 years old

23-54 years old

55-64 years old

65-74 years old

75 years and older

Question Title

* 9. Please check one answer for your race/ethnic group.

American Indian

Black non-Hispanic

Asian/Pacific Islander

Hispanic

White

Multi-ethnic (More than one)

Other (please specify)

Question Title

* 10. Please describe your disability. Check all that apply.

Cognitive Disabilities

Mental Health Disabilities

Physical Disabilities

Sensory Disabilities

Multiple Disabilities

Other (please specify)

Question Title

* 11. Do you have any other comments about the services that help you to live independently?

Use the space below to reply.

Question Title

* 12. What county do you live in?

	County
County	County County menu

Question Title

* 13. What region of the state do you live in?

	Region Listing (with each county listed by region)
Region	Region Region Listing (with each county listed by region) menu

Question Title

* 14. Do you live in a rural, urban or suburban location?

Rural

Urban

Suburban

Question Title

* 15. If you're completing this survey at home, skip this question. After clicking DONE, you will automatically be prompted for a chance to enter our sweepstakes.

If you are completing this survey at an IL Center and would like to be entered in our sweepstakes drawing for a $50 Mobil Gift Card, please complete the following...

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

NYSILC Needs Assessment Consumer Survey - FINAL

Question Title

* 1. What are the most challenging issues you face day to day? Check all that apply.

Question Title

* 2. What services do you use that are most important for you to continue to live independently? Check all that are most important.

For definition of terms click here

Question Title

* 3. How available are the following services are in your area? Please rate each one.

For definition of terms click here.

Question Title

* 4. Rate the following items in order of which would make it easiest for you to access services at your local Independent Living Center.

Question Title

* 5. How else could your local Independent Living Center make it easier for you to access services? Please describe below.

Question Title

* 6. Where else do you go to receive services or support that help you live independently?

Check all that apply.

Question Title

* 7. If you have problems with service agencies, how often are you able to resolve them? Check one box.

Question Title

* 8. Please check one answer for your age range.

Question Title

* 9. Please check one answer for your race/ethnic group.

Question Title

* 10. Please describe your disability. Check all that apply.

Question Title

* 11. Do you have any other comments about the services that help you to live independently?

Use the space below to reply.

Question Title

* 12. What county do you live in?

Question Title

* 13. What region of the state do you live in?

Question Title

* 14. Do you live in a rural, urban or suburban location?

Question Title

Question Title

* 1. What are the most challenging issues you face day to day? Check all that apply.

Question Title

* 2. What services do you use that are most important for you to continue to live independently? Check all that are most important. For definition of terms click here

Question Title

* 3. How available are the following services are in your area? Please rate each one. For definition of terms click here.

Question Title

* 4. Rate the following items in order of which would make it easiest for you to access services at your local Independent Living Center.

Question Title

* 5. How else could your local Independent Living Center make it easier for you to access services? Please describe below.

Question Title

* 6. Where else do you go to receive services or support that help you live independently?Check all that apply.

Question Title

* 7. If you have problems with service agencies, how often are you able to resolve them? Check one box.

Question Title

* 8. Please check one answer for your age range.

Question Title

* 9. Please check one answer for your race/ethnic group.

Question Title

* 10. Please describe your disability. Check all that apply.

Question Title

* 11. Do you have any other comments about the services that help you to live independently? Use the space below to reply.

Question Title

* 12. What county do you live in?

Question Title

* 13. What region of the state do you live in?

Question Title

* 14. Do you live in a rural, urban or suburban location?

Question Title

* 2. What services do you use that are most important for you to continue to live independently? Check all that are most important.

For definition of terms click here

* 3. How available are the following services are in your area? Please rate each one.

For definition of terms click here.

* 6. Where else do you go to receive services or support that help you live independently?

Check all that apply.

* 11. Do you have any other comments about the services that help you to live independently?

Use the space below to reply.