Claremont Special Needs Survey

Claremont Special Needs Assessment Survey
The City of Claremont is conducting a survey of special needs youth and young adults to assess needs and determine how we can best serve you. The survey is open to all special needs families or adults who live in Claremont.

The survey will remain open until September 15, 2023.
Questions
1. Would you be interested in a Claremont-based support group?

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1 is No, 10 is Yes
Please explain
2. Do you feel like there are adequate accommodations and resources available?

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1 is No, 10 is Yes
Please explain
YesNo
If yes please list
YesNo
If yes, please list
5. Are there any events you would like to see held?
6. Do you feel welcomed and comfortable in Claremont public spaces?

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1 is No, 10 is Yes
Please explain
Demographic Information

(all information is voluntary)
0-5 years old6-12 years old13-17 years oldAdult
CognitiveAuditoryVisualDevelopmentalPhysicalOther
Any disability details or information you'd like to share?
YesNoOther
YesNo
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
YesNo
Thank you for completing this survey. If you have any questions or difficulties filling out the survey please contact Michelle Castillo at mcastillo@ci.claremont.ca.us or (909) 399-5356.
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Claremont Special Needs Assessment Survey