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How old are you?
 
0-15
 
16-20
 
21-25
 
26-30
 
31-40
 
41-50
 
51+
 
 
 
Are you related to anyone with a disability?
 
Yes
 
No
 
If yes, how?
 
 
 
 
Do you work with people who have disabilities?
 
Yes
 
No
 
If yes, what facility?
 
 
 
 
How important do you think it is for adults with disabilities to learn everyday skills such as dusting, vacuuming, dishes, etc.?
 
Strongly Agree
 
Agree
 
Neutral
 
Disagree
 
Strongly Disagree
 
 
 
Do you believe that it is important for those with disabilities to learn (if at all possible) how to write their name and know their phone number?
 
Strongly Agree
 
Agree
 
Neutral
 
Disagree
 
Strongly Disagree
 
 
 
How often have you seen a person with a disability out in the work force?
 
Very Often
 
Often
 
Sometimes
 
Rarely
 
Not at All
 
 
 
Do you think it is important for those with a disability to learn every work skills?
 
Yes
 
No
 
Other
 
 
 
 
Do you see the public treating disabled adults fairly?
 
Yes
 
No
 
Other
 
 
 
 
Should adults with disabilities do arts and crafts at least a couple times per week?
 
Yes
 
No
 
If yes, why?
 
 
 
 
Would you sign up your family member/friend (with their permission) up for a program that taught them skill building?
 
Yes
 
No
 
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