Needs Assessment Survey for Upper Cape Cod Community

Thank you for taking the time to complete The Arc of Plymouth and Upper Cape Cod's survey. Your feedback will be used to determine which of our services is most critical to support people with disabilities and their families on Cape Cod.

Completing this survey should take approximately 3-minutes.

Sharing your email address would be very helpful for possible future follow-up. Care to share?

Are you completing this survey on behalf of an organization, yourself or another person?

An organization or business

Myself or another person

Please provide the name of your organization/company:

Please provide your name:

Other:

What cities/towns are in your service area? If your service area is regional, country-wide, or state-wide, please indicate so.

Other:

What do you view as the three most pressing needs for families and individuals in your service area?

	Needs
Need 1
Need 2
Need 3

What services would you like to see more of in order to help support people with disabilities on Cape Cod?

Are you familiar with The Arc of Plymouth and Upper Cape Cod?

Yes

Which town do you reside in?

Which best describes your affiliation to disability services? (Check all that apply)

I am a person with a disability

I am a caregiver for a person with a disability

I am an aging caregiver for a person with a disability

I am a family member or friend of a person with a disability

I am a guardian of a person with a disability

Other (please describe below)

Please describe:

What type of disability applies to yourself, your family member, or someone you know? (Check all that apply)

Are you, your family member, or someone you know with a disability getting the services they need?

Yes

Not Sure

Are you, your family member, or someone you know with a disability receiving state funded services? (If so, check all that apply)

Department of Developmental Services

Mass Rehabilitation Commission

Department of Mental Health

Other:

Other state funded services description:

Does your family member or someone you know currently receive support in any of the following areas? (Check as many as applicable)

Educational Transitional Services (i.e. Age 22)

Residential Services (i.e. Adult Family Care, Shared Living, Group Home, Individual Home Supports)

Financial Support (i.e. Agency With Choice, Department of Education Secondary Education, Family Support)

Day Habilitation Program

Day Services

Social Recreation Support

Autism Support Services

Do you or the person you know with disabilities have any unmet needs? If yes, what are those needs?

If you, your family member, or someone you know is already receiving disability services, how satisfied are you/they with their current services? Please choose one:

Reasons why you are dissatisfied:

What is your primary mode of transportation?

Other mode of transportation:

The Arc of Plymouth and Upper Cape Cod has many virtual offerings for families and people with intellectual and development disabilities, autism, and brain injuries. Examples of virtual offerings include Small Group Sessions focused on socialization with peers, employment skill building and educational trainings. Are you interested in learning more about these virtual offerings?

Yes please

No thank you

Do you have technology to access virtual offerings?

Yes

Unsure

Which of the following offerings interest you the most? (Check all that apply)

Employment Support Services (resume writing, mock interviews etc.)

Socialization and Fun

Hobby Exploration

Wellness and Health

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