Autism Calgary's Community Participation Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Autism Calgary has a partnership program with the City of Calgary's Family and Community Support Services (FCSS). One of the goals of this program is to ensure that the families we support feel socially included, and part of the Community. We kindly ask that you take a couple minutes to fill out this short survey! Your information remains anonymous to the City of Calgary.

Your input helps us continue the work we do, and allow us to learn how we can better support families! One of our Family Support Workers will reach back out to follow-up in a few months!

Thank you in advance for sharing!

Email *

Todays Date: *

YYYY

First Name & Last Name *

Birthday: *

YYYY

Phone Number: *

Are you new to Calgary? If so, when did you come here? *

Name of Neighborhood *

What is your primary language spoken at home? *

How many adults are in the household? *

How many children under the age of 18 are in the household? *

1. My neighbors tell me their news or I tell them mine:
*

Never or Almost Never

Rarely

Occassionally

Quite Often

Very Often

Always or Almost Always

2. I chat with my neighbors:
*

Never or almost never

Rarely

Occasionally

Quite often

Very often

Always or almost always

3. I take an active part in organized group activities in my community:
*

Never or almost never

Rarely

Occasionally

Quite often

Very often

Always or almost always

4. I am an active member of at least one sporting, hobby or community-based club or association:
*

Never or almost never

Rarely

Occasionally

Quite often

Very often

Always or almost always

5. I attend events that bring people together such as parties, shows, festivals, or other community events:
*

Never or almost never

Rarely

Occasionally

Quite often

Very often

Always or almost always

Do you have any feedback for Autism Calgary's Family Support Team?

FOIP Statement:

This information is collected under the authority of the Freedom of Information and Protection of Privacy Act (FOIP) Section 33(c) for the purpose of program evaluation and planning. The data will not be shared beyond The City of Calgary and the agencies that collected it, where it will be aggregated, analyzed and reported. The findings will be used to determine overall program effectiveness to improve services for all participants. Completion of demographic and survey data is voluntary. If you have any questions about the use of the information, please contact The City of Calgary at fcss.indicators@calgary.ca and a Research Social Planner will respond.

I read and agree to the above statement

Required

Signature: *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Autism Calgary Association. Report Abuse

Forms