Young Adult Inclusion Activities Parent Survey

If you are a parent of an adult 21 or older who has disabilities and living at home with you, please consider taking this brief (10 minutes or less) survey. Starbridge is interested in learning more about your young adult's participation in community and recreational activities. Please respond by Monday, July 13, 2015. Thank you.

Question Title

* 1. In regards to your son or daughter who has a disability, how old is your son or daughter?

21-25

25-30

30 or older

Question Title

* 2. What type of disability does your son or daughter have?

developmental disability

other disability

no disability

Question Title

* 3. Does your son or daughter participate in any inclusive recreational or community activities?

Yes

Question Title

* 4. Does your son or daughter receive support to participate in activities from a parent, staff person, peer or other adult?

Yes

Other (please specify)

Question Title

* 5. In what activities does your son or daughter participate?

Question Title

* 6. If your son or daughter does not participate in activities, why not? Please check all that apply.

Need support to participate

Tried in past unsuccessfully to participate

Have not identified an activity of interest

Not aware of opportunities

Group leaders do not understand how to support someone with a disability

Worried that it might not be a good experience

Do not feel welcome

Question Title

* 7. Would your son or daughter be interested in participating in inclusive activities with the support of a trained volunteer?

Yes

Question Title

* 8. Contact Information

Name:

Address:

Address 2:

City/Town:

Zip:

Email Address:

Phone Number: