YOUR OPINION COUNTS!
On behalf of the board of
directors at Arizona Bridge to Independent Living (ABIL), thank you for taking
the time to complete this very important survey. Your thoughts and opinions are
important to us as we direct the future of ABIL.
Which
of the following services provided by ABIL do you or a family member utilize?
Check any box that applies.
q Advocacy q Community
Living Options q Personal
Assistant Services
q Information & Referral q Home Modification q Personal Care/Homemaking
q Volunteer Peer Mentoring q Reintegration from Nursing Homes q SSA Work Incentives Counseling
q IL Skills Instruction q Empowering Youth in Transition q Ticket to Work Employment Services
q Outreach to Rehab Centers q ADA Technical Assistance q “This Is My Life”- Self Determination
Are there other services not
currently provided by ABIL that you would like to see offered? If so, please list below.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Which of the following ABIL
social/recreational programs have you or a family member participated in?
q Bowling q Cooking Group q Craft Group
q Cultural/Museum events q Dolly Boat Ride q Sporting events
q Movies q Newsletter Assembly q Planning Committee
q Other ________________________________________________________________________
Are there other programs not
currently provided by ABIL that you would like to see offered? If so, please list below.
____________________________________________________________________________________________________________________________________________________________________________________
Are you a regular reader of
the ABIL newsletter The Bridge? q YES q NO
What information published in
The Bridge do you find most helpful?
q Advocacy Alerts q Calendar q Classified Ads q Event Announcements q Q&A’s
q Other ________________________________________________________________________
Is there other information
not currently seen in The Bridge that you would like to see
offered? If so, please list below.
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please rate the following by circling a number from 1 – 5 ( with 5 being the highest rating, 1 the lowest) :
Courteousness of ABIL staff 5 4 3 2 1
Convenient access to ABIL offices 5 4 3 2 1
Responsiveness of ABIL staff to your requests 5 4 3 2 1
Is there anything else you’d like to add? Other areas for improvement? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
For demographic purposes, please answer the following:
How long have you been associated with ABIL? _________
In what capacity?
Consumer ____ Friend /supporter ____ Service Provider ____ Volunteer ____ Other ______________
Are you a person with a disability? Yes ___ No ____
Are you a family member of a person with a disability? Yes ___ No ____
May we contact you about volunteer opportunities? If so, please print your name and contact information below.
Name_____________________________________________________ Phone (______) _______________________
If you would like this survey to remain confidential, you may also call the ABIL main office at (602) 256-2245 to inquire about volunteer opportunities.
Thank you for taking the time to provide us with your feedback! We look forward to serving you in the future.