RDSB 2006
Needs Assessment Survey

Introduction

The Rockbridge Disability Services Board conducts a survey every three years to develop ways to assist citizens with PHYSICAL and/or SENSORY disabilities. This survey will be used by the RDSB to develop a Needs Assessment Report. This report will determine what areas need funding to promote the independence of people in ROCKBRIDGE who have PHYSICAL and/or SENSORY disabilities.

Instructions

If you have a physical and/or sensory disability, please take the time to print and fill out the survey form and mail it to:

Rockbridge Disability Services Board
P.O. Box 774
Lexington, VA 24450

You may also fill out the survey for a friend or family member, and if you prefer to complete this survey by telephone, please call 463-2472. Or FAX completed surveys to 463-9887.

Please mark your answers in the boxes on all four pages of the form. Comments are welcome. Use space provided or attach a separate sheet.

The form will open in a new window. Use the print command in your browser's file menu to print it (be sure you have four sheets of paper loaded). Then simply close the window to get back to this page.

Survey Form

SURVEYS MUST BE RETURNED TO THE DSB STAFF OFFICE NO LATER THAN JANUARY 6, 2006 TO BE CONSIDERED FOR THE REPORT.