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* 1. Date Completed

Date

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* 2. What is the age range of the person who receives services?

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* 3. Survey completed by:

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* 4. Was the communication from Aspire regarding the agency’s operational and safety plans during COVID-19 timely and informative?

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* 5. Were you satisfied with the frequency of communication from Aspire in general during COVID-19?

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* 6. What is the best way for you to receive information or updates from Aspire? (Please check all that apply and provide phone number and/or email). *Please note, by providing your phone number and/or email address, you consent to receive communication from Aspire via this method*

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* 7. Which service(s) do you receive from Aspire of WNY? (Please check all that apply)

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* 8. Regarding the specific service(s) you receive from Aspire, were you satisfied with the frequency that your service team(s) contacted you regarding your safety and well-being during COVID-19?

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* 9. Did you continue to receive services from Aspire during COVID-19?

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* 10. Did you receive services in person or virtually?

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* 11. If you received services virtually, how did these services meet your needs as compared to the services you received before?

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* 12. If you received services virtually, would you want the option to continue receiving services this way?

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* 13. If you continued to receive services in person, did you feel safe with the precautions taken by staff?

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* 14. If you continued to receive services in person, did the services meet your needs? Why/why not?

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* 15. If you have not received your normal services during COVID-19, do you feel that Aspire is taking adequate safety measure to keep you safe upon the reopening of that service?

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* 16. Please indicate any concerns you have with returning to programs.

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* 17. When returning to services, will wearing a mask present any difficulties for you?

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* 18. Was there anything that changed with the service(s) you receive from Aspire during COVID-19 that you liked?

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* 19. If you answered Yes to Question 18, please tell us what the changes were that you liked.

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* 20. Would you like these changes to continue?

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* 21. Are there areas that you have discovered you need more assistance with due to not receiving services or receiving limited services during COVID-19?

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* 22. If you answered Yes to Question 21, please share with us the areas you feel you need more support?

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* 23. What did you miss most about your Aspire services during COVID-19?

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* 24. What could Aspire have done differently to support you during COVID-19?

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* 25. Is there something that we can do to help you navigate this new environment?

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* 26. If you or your loved one lives in an Aspire IRA Group Home, how safe do you feel you/they were kept during the pandemic?

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* 27. If you or your loved one lives in an Aspire IRA Group Home, do you feel you received good communication from Aspire during the pandemic?

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* 28. If you or your loved one lives in an Aspire IRA Group Home, was there anything more Aspire could have done to support you/your family member during the pandemic?

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* 29. If you or your loved one receives any Day Service from Aspire, what type of community outings or activities would you feel safe/confident participating in?

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* 30. If you or your loved one receives any Day Service from Aspire, was there anything more Aspire could have done to support you/your family member during the pandemic?

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* 31. Would you like a personal response to your survey feedback?

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* 32. If you answered yes to question 31, please provide us your name and contact information so we may contact you.

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