Adult Placement Questionnaire

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The transition to adulthood and adult placement for individuals with intellectual or developmental disabilities can be daunting. All answers to this survey are kept confidential and names are not required unless you request more information at the last question.

Do you have a relative who has an intellectual or developmental disability between the ages of 18 and 99? *

Yes

Do you have a relative who has an intellectual or developmental disability between the ages of 3-18 *

Yes

When considering adult placement for your relative with a disability- what location would best fit your needs? *

rural farmland

outside of the city, but with access to town on a regular basis

in a small town

in a large city

Required

When considering adult placement for your relative with a disability- would you want them in a single apartment or sharing with a friend? *

I would only want them to live alone

I would only want them to live with a friend that we choose

I would only want them to live with a friend that was assigned from the community

I would not have a preference on my relataives living arrangements

Required

When considering adult placement for your relative with a disability- I would like to see *

full kitchen in the room

full kitchen on each floor used with partial supervision

meals provided for my relative (they cannot cook for themselves)

Meals provided for my relative (they can microwave or reheat things in their room)

Required

When considering adult placement for your relative with a disability- I would like to see a level of support that *

provides daily check in on my relative through a Resident Advisor on each floor

provides weekly check in on my relative through a Resident Advisor on each floor

provides check ins on my relative once every two weeks

does not provide any support to check in on my relative.

Required

I would like see these amenities for my relative (check all that apply) *

exercise room/weight room

laundry room

living room type lobby with board games and activities

pool

common room with video games and electronics

Other:

Required

Transportation would need to be... *

provided by the facility

my relative can take public transportation with partial assistance

my relative can take public transportation with no assistance

my relative can drive or has a care provider for transportation

Other:

Required

Outside amenities I would like to see close to the housing facility would include (check all that apply.) *

Educational Classes

Recreational Classes

Argicultural Opportunities for learning and employment (farming)

Sports Complex with multiple types of fields

retail within walking distance

employment opportunities within walking distance

aquatics center

gym

Other:

Required

When considering adult placement, I would like to *

buy a condo unit

rent an apartment

have shares of a faciilty

purchase through a special needs trust and have adult pay rent to the trust

Other:

Required

When considering adult placement, I consider a reasonable cost to be (check all that apply) *

Rent: Under $800 (no amenities)

Rent: 800-1200 (some amenities)

Rent: over 1200 (some amenities)

purchase under $125,000 (plus amenities/HOA fee)

purchase $126,000- $175,000 (plus amenities/HOA fee)

Co-op Share (Pay $50,000 to buy in, rent $400 a month plus HOA/amenities fee)

Other:

Required

I would consider this placement for my relative to be *

short term rental until another solution comes available

long term rental

permanant placement

Other:

Required

I would like more information on future neighborhood developments. Please add me to your email list (not required)

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