• AZSILC NEEDS ASSESSMENT SURVEY 2024

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  • The Arizona Statewide Independent Living Council (AZSILC) is conducting a survey to gather information about programs and services that provide support and opportunities for people who have disabilities in Arizona to live full lives in the community. 

    Arizona Statewide Independent Living Council seeks responses directly from people who have disabilities, their family members, friends, caregivers, and other stakeholders.

    Your response is anonymous. Thank you again for taking the time to share your thoughts and ideas.

    This survey is available in alternative formats upon request. Please email operations@azsilc.org or call 602-262-2900 for further information. 

     

  • GENERAL INFORMATION

  • Please check all that apply.*
  • Check here if you are familiar with the Arizona Statewide Independent Living Council (AZSILC).*

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  • 5. Have you contacted a Center for Independent Living for information, assistance, or services during the past 12 months? *
  • 6. If yes, please check the box next to the Center for Independent Living you contacted for services.
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  • 9.   Please respond to the following questions regarding COVID-19.

  • I received the health services I needed during the pandemic*
  • I want to get the COVID-19 vaccination*
  • I received the COVID-19 vaccination*
  • I need help getting the COVID-19 vaccination*
  • I chose not to, or have been advised not to get the COVID-19 vaccination *
  • 10. What makes it hard for you to get the services you need? (Check all that apply)*

  • 11. What keeps you from living more independently and participating in your community? (Please check all that apply)*
  • 12. Did you vote in the last election?*
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  • DEMOGRAPHIC INFORMATION

  • The following questions will help evaluate who participated in the survey. Answering these questions is helpful, but optional. If you do not wish to provide a response click the submit button at the bottom of the page.

  • 2. Type of disability? (Choose all that apply)
  • 3. Age?
  • 4. How would you describe your ethnicity? (Choose all that apply)

  • 5. What is your annual household income?
  • 6. How would you describe your living arrangement?
  • 7. What is your highest level of education?
  • 8. What is your current employment status? (Choose all that apply)
  • 9. Are you active in the US Military or a veteran?
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