ASK Each Other Virtual Support Group

The remaining questions are required for the purpose of our grants. Your personal information will not be shared. If you are BOTH a parent and a professional, please answer about your own child.

Describe yourself (select all that apply):

• Parent of an individual with disabilities
• Professional who serves individuals with disabilities
• A youth with disabilities (Age 26 or younger)
• An individual with disabilities (Age 27 or older)

What is the primary language spoken in your home?

• English
• Spanish
• As a professional, I serve families who may speak various languages.
• Other
• I prefer not to answer.

Select the disability diagnosis of your child or the individuals you serve. If you are attending this event as an individual with a disability, select your own diagnosis. (select all that apply):

• ADD/ADHD
• Autism
• Deafness
• Deaf-Blind
• Hearing Impairment
• Intellectual Disability
• Mental Health/ Behavioral Health Disability
• Developmental Delay
• Learning Disability
• Multiple Disabilities
• Orthopedic Impairment (physical)
• Other Health Impairment
• Speech/Language Impairment
• Traumatic Brain Injury
• Visual Impairment including Blindness
• Suspected disability/Not yet identified
• No disability
• As I professional, I serve all disabilities.
• I prefer not to answer.

Select the age of your child or the individuals you serve. If you are an individual with a disability, select your own age. (select all that apply):

• Birth-3 years
• Age 4-5 years
• Age 6-11 years
• Age 12-13 years
• Age 14-26
• Age 27+
• As I professional, I serve all ages.
• I prefer not to answer.

Select the race of your child or the individuals you serve. If you are attending this event as a person with a disability, select your own race. (select all that apply):

• African American/Black
• American Indian/Native American/Alaskan Native
• Asian
• Caucasian/White
• Native Hawaiian/Pacific Islander
• Two or more races
• As I professional, I serve all races.
• I prefer not to answer.

Select the ethnicity of your child or the individuals you serve. If you are attending this event as an individual with a disability, select your own ethnicity. (select all that apply):

• Hispanic / Latino
• Non-Hispanic / Non-Latino
• As a professional, I serve families of all ethnicities.
• I prefer not to answer.