Independent Living Public Questionnaire

 

We are looking for your input on issues that affect your daily life. 

We are interested in how these issues have affected you, what, if anything, you have done to change your situation in regard to the issue and what you think SILC and the Centers for Independent Living network can do to help address each concern.

Below, we've provided a list of issues that we'd like your input on. The topics are only suggestions, you also have an option to fill in your own issue. We ask that you select your top five issues and for each provide a short explanation of why you've made this selection.

Please provide your First Name and (if desired) your Last Name
Please provide your Email Address if you would like to be added to our mailing list.
Please provide your County of Residence

1. For this list of issues, please select one which has the greatest impact on your life (you'll be asked to select 5 total to comment on). Please explain how this issue most affects you in the comment box below.

2. For this same list of issues, please choose (if desired) another that has an impact on your life and tell us how it has affected you.

3. Please select another issue and explain how it has affected you, below.

4. Please select another issue and explain it's impact for you below.

5. Please select one final issue that has impacted you and provide information about its affect, below.

We thank you for your input. Please click the submit button below to submit your responses. You'll receive email confirmation of your submission.