Cultural Diversity Public Outreach Survey
1.
What services do you or your family member receive from VMRC?
Behavioral Services
Community Care Home/ICF/etc.
Day Program
Early Start Services
Employment Services
Respite
Tele-Medicine
Transportation
Other (please specify)
2.
Do you feel these services are adequate for you or your family member
Yes
No
Other (please specify)
3.
Are you satisfied with the help your Service Coordinator provides to you and your family?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
4.
How can VMRC better assist you or your family member to meet their needs and goals?
5.
Which race/ethnicity best describes you? (Please choose only one.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
Mixed Race
6.
What county do you reside?
Amador
Calaveras
San Joaquin
Stanislaus
Tuolumne
Other (please specify)
7.
If you have a need for another language or question about survey please contact Cultural Specialist Carlos Hernandez 209-955-3380 or indicate below your preferred language or question.
Current Progress,
0 of 7 answered
