DHHS- VR SILC- Family, Friends, and Provider Survey

Independent Living Needs Assessment

Survey for Family, Friends, and Providers
The Statewide Independent Living Council (SILC) invites you to participate by completing the below Needs Assessment Survey. Your input will play an important role in developing the 2027-2029 State Plan for Independent Living (SPIL).

This survey will take about 10-15 minutes to complete. Participation is voluntary, and all responses are anonymous – no identifying information will be connected to your answers. The data will be used for statistical purposes only.

Thank you for taking the time to help strengthen independent living services in North Dakota.
YesNo
What county do you live in?*
Not ApplicableFort BertholdBelcourtSpirit LakeStanding RockTurtle MountainOther
YesNo
YesNo
LocationTransportationCostHousingDisability AccessLanguageOther
Are there any services that would be helpful to someone you know to fully participate in events and activities in the community?

Mark all that apply for each topic in this section
Knowledge of community servicesAffordable and accessible housingA ride to church, shopping, visiting, medical etc.Other
Adaptive equipmentHelp with cleaning the houseHelp with meal preparationHelp with bathing, dressing, toiletingHelp finding employmentHelp with planning your careerHelp with applying for services/benefitsMoney management (Help with money)Peer support (talking to someone with a similar disability)Other
A ride to church, shopping, visiting, medical, etc.Access to disability resource informationPeer Support (Talking to someone with a similar disability)Adaptive equipmentAccess to medical careAccess to dental careAccess to mental health careAccess to social activitiesOther
Are there any areas that a Center for Independent Living can help someone you know to live more independently or find appropriate resources?

Mark all that apply for each topic in this section
Keeping my home cleanLiving on my ownCookingEatingBathing/DressingTaking my medicationsMoney ManagementShoppingSafetyOther
Home modificationsRampsBath equipmentMoney to fix my houseNew and better housingLarge Print/BrailleTransportationGetting a driver's licenseMaking my favorite places accessibleTaking care of children/familyBeing involved in community activitiesShoppingPaying for medicationsAccess to DentistsAccess to medical specialistsAccess to eye doctorsOther
Money to fix my houseHousing assistanceInterpreter serviceLarge Print/BrailleGetting a jobKeeping a jobTransportationGetting a driver's licenseTaking care of children/familyHome delivered mealsDoing yardworkVeteran servicesCounty servicesSocial Security DisabilityGetting medicationsAccess to DentistsAccess to medical specialistsAccess to eye doctorsPersonal attendant services (caregiver)Other
Being involved in community activitiesDiscrimination in the communityDiscrimination at workGetting a jobShoppingControlling emotionsFear of acceptanceOther
In your opinion, what are the most important independent living issues to focus on in the next 3 years?
Should be Empty:

Independent Living Needs Assessment

Are there any services that would be helpful to someone you know to fully participate in events and activities in the community?

Are there any areas that a Center for Independent Living can help someone you know to live more independently or find appropriate resources?