Community Participation Measure Test

Go shopping?

Go shopping for pleasure or entertainment (e.g., at a grocery store, convenience store, shopping center, mall, another retail store, flea market, or garage sale.)

Question Title

* 1. Unique Identifier #

Name

Question Title

* 2. Do you do this activity?

Enough

Not Enough

Too Much

Question Title

* 3. Is this activity important to you?

Yes

Question Title

* 4. Number of Days
(without a staff person)

Clear

i We adjusted the number you entered based on the slider’s scale.

Community Participation Measure Test

Go shopping?

Question Title

* 1. Unique Identifier #

Question Title

* 2. Do you do this activity?

Question Title

* 3. Is this activity important to you?

Question Title

* 4. Number of Days(without a staff person)

* 4. Number of Days
(without a staff person)