What matters to you?
It's important to us!
IMPORTANT INFORMATION ABOUT THIS SURVEY

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Advocacy, Inc. wants to make sure our services match the things that matter most to
people with disabilities in their every day lives. To do that, we ask people with disabilities,
their families and friends, disability advocates and others to tell us about things that
are most important to them. You can help by taking a few minutes to take this survey.

Please remember, there are no wrong answers. We want to know what is important to you in your daily life.

For help filling out the survey, call 1-888-665-6602 (free)

DEADLINE: March 31st, 2010

Advocacy, Inc.
7800 Shoal Creek, Blvd., #171-E
Austin TX 78757

Section 1: Your Important Issues

  1. Read the list below (A–Z) all the way through before marking your choices.
  2. Put a mark by the 5 things that are most important to you in your every day life.
    (Note: If you are helping someone with a disability fill out this form, please let them choose 5 things. If you are a parent, guardian, advocate or professional, we welcome your own choices based on your experiences and relationships with the people with disabilities in your life.)
  3. Please Note: You cannot select more than 5 choices
  4. If you want to add any comments to the survey, write in the the comment box at the end of this page.

Section 1: The five things that are most important to me in my daily life are:

Section 2: About You

(If you are helping somebody complete this survey, please check the boxes that apply to them)

Your zip code:

Your age group:

Your race:

Other Click the option first for the write-ins

You are a:

Professional:

Comments (if any)