Community Survey

Question Title

* 1. How familiar are you with the programs and services provided by Wyandot County Developmental Disabilities/Angeline?

Extremely familiar

Very familiar

Somewhat familiar

Not so familiar

Not at all familiar

Please explain.

Question Title

* 2. Which of the following programs or services would you like to know more about? (check all that apply)

SSA/Case Management Services

Early Intervention/PLAY Project

Family Support Services

Angeline Pre-School

Angeline School-to-Adult Life Transition (SALT) /Project LIFE Program

Angeline Industries/Adult Services

Medicaid Waiver Home & Community-Based Services (HCBS)/Supported Living

Other (please specify)

Question Title

* 3. How satisfied are you that the programs and services of Wyandot County DD/Angeline meet the needs of local citizens with developmental disabilities and their families?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

Please explain.

Question Title

* 4. Please tell us how Wyandot County DD/Angeline can better meet the needs of Wyandot County citizens with developmental disabilities and their families.

Question Title

* 5. Are there any other comments you wish to share?

Question Title

* 6. Thank you. Your input is important to us. Your contact information is optional and confidential. If you requested information about our programs and services, please provide your contact information below so we may follow-up.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number