2024 ServeMontana Accommodation Assessment Question Title * 1. Which National Service program are you currently serving with? (Please read all options carefully) AmeriCorps VISTA National Direct (Montana Conservation Corps, Habitat for Humanity, Jesuit Volunteer Corps Northwest, PHA etc.) AmeriCorps Seniors (Foster Grandparents, RSVP, or Senior Companions) Big Sky Watershed Corps Justice for Montanans Project Montana Campus Compact (non-VISTA) Montana Public Health Corps Montana Fish, Wildlife, and Parks AmeriCorps AgCorps Other (please specify) Question Title * 2. Are you a: First year member Second year member Third year/plus member Question Title * 3. What city or region is your primary service location? City Region Question Title * 4. When you applied to serve in your program were you aware of the availability of reasonable accommodations*?*Reasonable Accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.A reasonable accommodation must be feasible or plausible for the employer and must enable the individual to perform the essential functions of a position.Reasonable accommodation examples include auxiliary aids/services, CCTV, an amplified audio listening device, a sign language interpreter, materials on audio tape, enlarged text documents, or adjusted work schedules. Yes No Question Title * 5. Do you consider yourself to be a person with a disability*? *The Americans with Disabilities Act defines disability as a physical or mental impairment that substantially limits one or more major life activities of an individual, a record of such an impairment, or being regarded as having such an impairment. For more definitions, visit: www.ada.gov Yes No Prefer not to disclose Question Title * 6. Please check any of the following conditions that substantially limit one or more of your major life activities, if you have a record of, or are regarded as having such impairment. Definitions at: https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm None Prefer not to report Multiple sclerosis Head injury ADD or ADHD Anxiety Disorder Asthma Pulmonary Disability Stroke Blind/Visual Impairment Amputation Speech Impairment Depression Deaf/Hard of Hearing Bipolar disorder Autism Diabetes Learning Disability Epilepsy HIV/AIDS Cerebral Palsy Cancer Muscular Dystrophy Spinal Cord Injury Environmental Sensitivity Chemical or alcohol dependency Other (please specify) Question Title * 7. Have you disclosed* a disability to any staff persons in your organization? *Disclosure can happen in a number of ways, from an informal conversation to a formal, written request for an accommodation. It can happen at any time during the term of service, but it should occur as soon as a person realizes they may need an accommodation. N/A Yes No Question Title * 8. If you have a disability, have you requested a reasonable accommodation for your term of service? N/A Yes No Next