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- How are you connected to the developmental disability community? (select all that apply)*
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- Which regional center, if any, do you or the person you support use?
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- If you support a person with a disability, what is their age?
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- What is your gender identity?
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- What are the top three issues The Arc of California should prioritize in the coming year from the list below? (select three)*
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- Which of the following regional center or disability services have been most helpful to you in the past 12 months? (select all that apply):
- Are your current support services meeting your needs?
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- What barriers, if any, have made it difficult to access services? (select all that apply)
- Would you like help connecting to additional services or supports?
- During the last 12 months, was any of the following care delayed or services not received?
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- Are you, or the person you support, currently enrolled in Medi-Cal?
- During the past 12 months, have you, or the person you support, experienced any problems with Medi-Cal benefits? (select all that apply):
- Which Medi-Cal-funded services are you most concerned about losing or having reduced? (select all that apply):
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- During the past 12 months, have you, or the person you support, experienced any problems with food benefits? (select all that apply):
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- During the past 12 months, have immigration concerns caused you, the person you support, or your family to do any of these things? (select all that apply):
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- Which statements describe the current home? (select all that apply):
- Are you, or the person you support, looking for a different place to live?
- How long have you or the person you support been waiting for affordable or accessible housing?
- What has made it difficult to find housing? (select all that apply):
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- What best describes your employment status?*
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- During the past 12 months, did you experience any of these employment problems? (select all that apply):
- What would help you find or keep a job? (select all that apply):
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- During the past 12 months in what ways have you engaged in The Arc of California’s advocacy activities? (select all that apply).
- How likely are you to participate in future advocacy or engagement opportunities with The Arc of California?
- Which social media platforms do you use most? (select all that apply).
- How do you prefer to receive updates from The Arc of California? (select all that apply).
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- Would you be willing to share your story publicly or with legislators?*
- May The Arc staff contact you about your responses?*
- Do you want to be entered into the raffle drawing for prizes? If yes, please add your name, email and phone number below.*
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Format: (000) 000-0000.
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- Should be Empty: