July 2006
This letter comes from the Independent Living Committee. This committee includes representatives of Deaf, Hard-of-Hearing, Deaf-Blind and Hearing/Vision Impaired communities.
We would like to learn more about your experiences and needs for Independent Living (IL) Services. IL means access to the communication of your choice to learn new skills, increase knowledge and make decisions for a more satisfying and independent life (ex. cooking, managing money, problem solving, housing).
Please answer the following questions to help us better understand your need for any adjusted or additional services.
Your feedback and information about your needs will be presented to the Washington State Independent Living Council (SILC) and may be included in the upcoming state plan. The plan will cover the time period of 2007-2009.
We would appreciate you completing this survey by August 18, 2006. Your name and identifying information will be removed before your survey answers are passed on.
Please send responses to: pallen@silverlink.net
Or you may print out the survey and use the postal service to mail it to:
Division of Voc Rehab (DVR)
PO Box 45340
Olympia, WA 98504-5340
Attn: IL Survey KK
Thank you!
SURVEY QUESTIONS: (Check all that apply)
1. Are you: Deaf Deaf-Blind Hard-of-Hearing
Hearing and Vision Impaired
2. What city do you live in? ________________.
3. When you go to request services, do you have access to the mode of communication you prefer? Is communication clear? Yes No
If yes, what type of communication?
€ ASL/PSE Interpreter
€ Total Communication
€ Oral Interpreter
€ Tactile
€ Close Visual
€ FM System
€ Captioner
€ Minimal Language Skills (MLS)
4. Have you had Independent Living (IL) services in the past? Yes No
If yes, with Deaf IL Services Deaf-Blind IL Services
Hearing IL Services
5. Were you satisfied with the quality of the service? Yes No
If no, why not?
6. Do you have any issues related to maintaining employment? Yes No
a. Related to IL Yes No
b. Related to Vocational Rehabilitation (VR) Yes No
7. What area do you want to improve and what service do you need? (Check all that apply)
Daily Living:
€ Food Shopping
€ Cooking
€ Health
€ Hygiene
€ Public Transportation
€ Money
€ Personal Safety
€ Laundry
€ Housekeeping
€ Appearance & Clothing
Increase knowledge:
€ Decision making
€ Problem Solving
€ Consumer's Rights
€ Self Advocacy
€ Housing
€ Time Management/Scheduling
€ Insurances/Investment/Loan
€ Nutrition
€ Driving
Communication/Social/Interpersonal:
€ Social Skills
€ Build social networks
€ Find community resources
€ Assistive Technology (i.e. pager, computer, Braille note, FM)
€ Basic Skills ( English, Math, ASL)
€ Learn Braille
€ Manners
€ Interpersonal
8. Are you interested in joining a support group (i.e. Job club, professional network)? Yes No
9. Do you have any more comments?
Optional and not required: If you have questions or want information about services, please give your name and phone number or email and someone from the IL committee will contact you.
Name:
Phone/Email:
Question:
Please return the survey by August 18th. If you want to use the postal service, mail the survey to DVR, Attn: IL Survey KK, PO Box 45340, Olympia, WA 98504-5340.
Thank you for taking the time to answer our questions!
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