Health Information Binder Survey

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The NGCDD would like your feedback on the Health Information Binders! This survey should take less than 3 minutes!

Please check all that apply: *

I am a self-advocate or a person with an I/DD

I am a family member of a self-advocate

I am a professional or other

I live in a rural area of Nevada

I am a male

I am a female

I identify as other than male or female or I choose not to tell you my gender.

Required

What is your race? *

I am Black or African American

I am White

I am Native Hawaiian or other Pacific Islander

I am Asian

I am Native American/American Indian

I am Hispanic or Latino

I am two or more races

I don't know what my race is or I choose not to tell you what my race is.

I feel this binder will help me increase my ability to advocate for myself or other people. *

Yes

I feel this binder will help me be better able to say what I want or need and what is important to me. *

Yes

I am currently able to advocate for myself. *

Yes

I am currently on a disability, policy or advisory board, or serving in a leadership position. *

Yes

I am satisfied with this binder! *

Yes

Do you have any additional comments?

Submit

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