The New River Valley Disability Services Board (NRVDSB) conducts a survey every three years to develop ways to assist citizens with PHYSICAL and/or SENSORY disabilities. This survey will be used by the NRVDSB to assist in the development of the 2006 Needs Assessment Report. This report will determine what areas need funding to improve the independence of people in Floyd, Giles, Montgomery, and Pulaski County and in the City of Radford who have PHYSICAL and/or SENSORY disabilities.
All responses will be kept confidential. Thank you for taking the time to participate.
INSTRUCTIONS If you feel you have a physical and/or sensory disability, please take the time to fill out the following questions. You may also fill out the survey for a friend or family member, and if you prefer to complete this survey by telephone, please call Ali Whitaker at 540-639-9313.
If you have any questions regarding this survey, please contact Ali Whitaker by phone at 540-639-9313 or by email at [email protected].
SURVEYS MUST BE SUBMITTED NO LATER THAN NOVEMBER 1, 2005 TO BE CONSIDERED FOR THE 2006 NRVDSB NEEDS ASSESSMENT.
1. What city or county do you live in? Choose One Floyd County Giles County Montgomery County Pulaski County City of Radford 2. I am Choose One an Adult (over 22) a Young Adult (19-21) a Child (0-18) 3. Type of Disability: (Check all that apply) Blind / Vision Impaired Deaf / Hard of Hearing Speech Impaired Physically Disabled Brain Injury Other ( Autism, Aspergers Syndrome, Chronic Medical, etc.) Describe: In this section, please select the best response from the drop down list. You may include any additional information in the comment section below. (All required) 1. Assistive Technology-Adaptive equipment-wheelchairs/visual aids/computers Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 2. Case Management-Coordinate programs and services Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 3. Counseling-Social workers, psychiatrists, rehab counselors Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 4. Education-Early Intervention to High School for youth with disabilities Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 5. Employment Services-Job preparation and job placement Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 6. Family Support Services-Counseling/case management to support family members Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 7. Accessible Housing-Accessed without physical barriers Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 8. Independent Living Services-As through Centers for Independent Living Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 9. Medical & Therapeutic Services-Accessible and affordable medical insurance & services Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 10. Personal Assistance Services-Help with daily living activities like cooking or household management Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly 11. Training-For employment or upgrading skills Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly
1. What city or county do you live in? Choose One Floyd County Giles County Montgomery County Pulaski County City of Radford
2. I am Choose One an Adult (over 22) a Young Adult (19-21) a Child (0-18)
3. Type of Disability: (Check all that apply)
Blind / Vision Impaired
Deaf / Hard of Hearing
Speech Impaired
Physically Disabled
Brain Injury
Other ( Autism, Aspergers Syndrome, Chronic Medical, etc.) Describe:
In this section, please select the best response from the drop down list. You may include any additional information in the comment section below. (All required)
1. Assistive Technology-Adaptive equipment-wheelchairs/visual aids/computers
Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly
2. Case Management-Coordinate programs and services
3. Counseling-Social workers, psychiatrists, rehab counselors
4. Education-Early Intervention to High School for youth with disabilities
5. Employment Services-Job preparation and job placement
6. Family Support Services-Counseling/case management to support family members
7. Accessible Housing-Accessed without physical barriers
8. Independent Living Services-As through Centers for Independent Living
9. Medical & Therapeutic Services-Accessible and affordable medical insurance & services
10. Personal Assistance Services-Help with daily living activities like cooking or household management
11. Training-For employment or upgrading skills Choose One Service is O.K. Service is not O.K. Service is needed but not available Service is needed but too costly
12. Transportation-Available and accessible for persons with disabilities
In this section, please identify the services in which you have an unmet need. (All required)
13. Assistive Technology-Adaptive equipment-wheelchairs/visual aids/computers
I have an unmet need for this service and it Choose One Seriously Moderately Slightly Not applicable affects me.
14. Case Management-Coordinate programs and services
15. Counseling-Social workers, psychiatrists, rehab counselors
16. Education-Early Intervention to High School for youth with disabilities
17. Employment Services-Job preparation and job placement
18. Family Support Services-Counseling/case management to support family members
19. Accessible Housing-Accessed without physical barriers
20. Independent Living Services-As through Centers for Independent Living
21. Medical & Therapeutic Services-Accessible and affordable medical insurance & services
22. Personal Assistance Services-Help with daily living activities like cooking or household management
23. Training-For employment or upgrading skills
24. Transportation-Available and accessible for persons with disabilities
COMMENTS:
Thank you for participating in the NRVDSB Survey!
Last updated 7/7/05