*
1.
Please select from the following options the title that best applies to you:
Administrator
Case Manager
Doctor
Family Member
Nurse
Occupational Therapist
Paraprofessional
Person with Disability
Physical Therapist
Psychologist
Speech & Language Pathologist
Student
Teacher
Other (please specify)
*
2.
How familiar are you with the IOD?
Not at all familiar
Somewhat familiar
Very familiar
*
3.
How did you learn about the IOD?
website
workshop
news media
email
flyer / brochure
published research
newsletter
community organization
friend
other
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4.
How would you describe the role of the IOD?
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5.
Have you received any supports or services from the IOD?
Yes
No
6.
If yes to question 4, what type/s?
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7.
Have you been satisfied with the supports and services from the IOD?
not at all satisfied
somewhat satisfied
very satisfied
have not received any
*
8.
Do you receive any IOD publications?
Yes
No
9.
If so, which ones?
10.
Are they helpful?
not at all helpful
somewhat helpful
very helpful
*
11.
Have you visited our website?
www.iod.unh.edu
Yes
No
*
12.
Do you find it to be a helpful tool when looking for information about trainings, resources, research and services related to disabilities?
not at all helpful
somewhat helpful
very helpful
never visited
*
13.
Is there information or features you would like to see added to the website?
Yes
No
Never Visited
14.
If so, what are they?
*
15.
What are the most important issues you think the IOD should be addressing?
*
16.
What do you think the best way for the IOD to connect with families and individuals with disabilities?
17.
Please check all the different programs within the IOD that you are familiar with.
Alliance for Community Support
APEX (Achievement in Prevention and Excellence)
AT in NH (Assistive Technology in NH)
Autism Ph.D. and Graduate Certificate Programs
Autism Summer Institute
Beyond Access
Beyond Access for Assessment Accommodations
CHANCE (The Center for Housing and New Community Economics)
Communication Skill Builders Group
Community Wrap
Continuing Education for Community Rehabilitation Personnel
Cornerstone
Developing Business Capacity to Include Employees with Autism
Early Connections
Early Markers
Equity and Excellence in Higher Education
Family Support Partnerships Project
Gaining Access
Granite Ladders
Home Care Connections
IF (Innovation Facilitators)
Inclusion Facilitator Training Program
Jumpstart: Early Success with Autism
Links to Early Learning
Literacy Summer Institute
Microboards - Enhancing the Transition to Adult Life
Nashua Youth Re-Entry
NH Family & Consumer Leadership Series
NH LEND (The NH Alliance for Leadership Education Excellence in Caring for Children with Neurodevelopmental and Related Disabilities)
NH Resource Center on Autism Spectrum Disorders
NH's Assistive Technology Partnership
Northeast Technical Assistance Center
NSIP (New Hampshire National Service Inclusion Project)
Paraprofessional Training
Partnerships for Educational Innovation
Real Choice Systems Change
Research to Practice
Rural Transportation Access Network
School-Based Transition for Students with Serious Emotional or Behavioral Disabilities
Seacoast Child Development Clinic
Self-Determination for Persons with Developmental Disabilities
Spring / Fall Symposium
Technical Assistance
Trainings & Workshops
Under One Roof: Family Support 360
Youth Empowerment Services (YES)
18.
Please include any additional comments you would like to share here:
Would you like to receive our newsletter with the latest IOD news, events, and workshops? If so, please fill out the following contact information to be added to our mailing list.
19.
First Name:
20.
Last Name:
21.
E-Mail Address:
22.
Please select the address where you would like correspondence sent:
Work
Home
23.
Title / Position:
24.
Employer / Organization:
25.
Address:
26.
City:
27.
State:
28.
Zip Code:
