Needs of Immigrants with Disabilities in Illinois
Description: The Disability & Immigration Taskforce of Illinois (DITI) is conducting this Data Survey in order to evaluate the needs of immigrants with disabilities in Illinois.

Deadline: Please fill this out by 5 pm on Friday, November 13, 2020. Survey respondents must live in Illinois at this time.

Disclaimer: DITI assures you that by choosing to participate in taking this survey, the information collected will ONLY be utilized to determine the needs of immigrants with disabilities and their caregivers. NO INFORMATION WILL BE SHARED with any government agency. DITI is not a government agency. Please answer all questions to the best of your ability.
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This survey is focused on the needs of immigrants with disabilities. Are you filling this out on your own behalf as a person with a disability, or on behalf of a person with a disability?
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What kind of disability do you have? (Indicate all that apply--if you are filling this out for someone else who has a disability, please indicate their disability).
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If you are filling this out on behalf of a person with a disability, please describe your role in their life. If you are a person with a disability filling this out for yourself, please skip this question.
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What is your preferred language(s)?
How well do you speak English? (We ask this to identify problems in getting access to information that is in English only.)  
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Do you identify as an immigrant?
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Please describe your immigrant status.
Are you the head of household?
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How many people reside in your household?
What is your annual household income?
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If you are a person with a disability, do you require support from a caregiver?
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Describe the activities of daily living with which you require assistance.
What is your age range?
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What is your education level? Please choose all that apply.
Are you employed?
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If you have a job, what is your job?
If you do not have a job, are you interested in getting a job?
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Have you experienced challenges in getting a job?
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If you have experienced challenges to getting a job, please describe them.
Do you have health insurance?
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If yes, what health insurance do you have?
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If not, what prevents you from getting the health insurance you need?
Do you rent or own housing?
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Is your housing situation affordable?
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If your housing situation is not affordable, why not?
Is your housing situation accessible for you as a person with a disability?
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If your housing situation is not accessible, what do you need to make it accessible?
What is your primary mode of transportation?
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Do you have a reduced fare or free ride card for public transportation?
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Is there anything else you would like to share with us in regards to accessing services like education, healthcare, or obtaining employment?
Have you or (your family?) avoided or dis-enrolled from public benefits because you are afraid of the public charge test? (yes/no/other)
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We would like to better understand why people would choose to dis-enroll or avoid public benefits. If you said yes to the previous question, please share why, and which benefits (optional).
If you would like to be considered to win a $50 gift card through a drawing, please provide your email or phone number. We would not use that information for any other reason.
Would you be willing to be contacted by DITI to share your story as an immigrant with a disability?
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Thank you for completing this survey!
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