Qualtrics Survey | Qualtrics Experience Management

Help us to understand your journey with disability and guide our future podcast content by answering the following questions.

As a requirement of continued funding, the podcast is required to seek race/ethnicity, gender, disability experience, and geography. Thank you for your consideration.

What is your race / ethnicity?

White, alone
Black or African American alone
American Indian or Alaskan Native alone
Hispanic / Latino
Asian alone
Asian Alone
Native Hawaiian & Other Pacific Islander alone
Two or more races
Race Unknown

Gender

Female
Male
Other

Disability Experience

Individual with a Developmental Disability
Family Member of an Individual with a Developmental Disability
Other

Geography

Urban
Rural

Sexual Orientation

GENDER IDENTITY (What sex were you assigned at birth):

Female
Male
Don’t know
Prefer not to answer

Did the Black Feathers podcast and/or supplemental resources help you to increase your knowledge on how to take part in decisions that affect your life, those of other, and systems?

Yes
No
I don't know

Are you currently engaged in advocacy activities?

Yes
No

Did the Black Feathers podcast and/or supplemental resources help you to in advancing your advocacy efforts?

Yes
No
I don't know

As a result of the Black Feathers podcast and/or supplemental resources are you interested in participating in disability coalitions, policy boards, advisory boards, governing bodies and/or serving in leadership positions?

Yes
No
I don't know

Did the Black Feathers podcast and/or supplemental resources support you in identifying what supports and services you need, want, or are important to you?

Yes
No
I don't know

Black Feathers Content

Black Feathers Content
	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Were you satisfied with the Black Feathers content?	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree