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Freedom Needs Assessment Questionnaire
What services or programs do individuals with disabilities need that are not offered or what areas do you feel that people are underserved in?
*
What Barriers, if any, do you or the individuals you know or work with, face which make it hard to be independent?
(Rate top 3 most important, 3 being the most important)
Lack of Educational Opportunities
1
2
3
Employment & Vocational Barriers
1
2
3
Public Attitudes/ Discrimination
1
2
3
Transportation
1
2
3
Personal Attendant Services
1
2
3
Lack of Knowledge of Services
1
2
3
Individual Attitudes
1
2
3
Physical Barriers
1
2
3
Professional Barrier
1
2
3
Housing
1
2
3
Financial Resources
1
2
3
Other(s)
1
2
3
If Others, please specify
What groups of individuals would you like to see Freedom do more outreach to? (Rate top 3 most important, 3 being the most important)
Nursing Homes & Assisted Facilities
1
2
3
Mental Health
1
2
3
People with TBI
1
2
3
People with Physical Disabilities
1
2
3
People with Intellectual Disabilities
1
2
3
Elderly
1
2
3
Minority Groups
1
2
3
Children
1
2
3
People with Sensory Disabilities
1
2
3
Other(s)
1
2
3
If Others, please specify
Name
*
First
Last
Email
*
Phone
Name
This field is for validation purposes and should be left unchanged.
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Core Services
Information & Referral
Individual & Systems Advocacy
Independent Living Skills Training
Peer Mentor
Transition Services
Additional Services
Home Access & Ramp Program
Workforce Innovation & Opportunity Act (WIOA)
Freedom In Action (FIA)
Accessibility Guide
Disability Laws
Discrimination Inquiry
Needs Assessment
Newsletter
About Us
About Freedom Resource Center
Blog
Contact
Contact Us
Career Opportunities
Donate
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