DHHS- VR SILC- Consumer Survey

Independent Living Needs Assessment

Survey for Consumers and Clients
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
Not ApplicableCognitiveMental / EmotionalPhysicalHearingVisualOther
YesNo
Live IndependentlyLive Independently with AssistanceLive with FamilyAdult Foster CareGroup HomeAssisted Living FacilityHomeless
YesNo
YesNoNot Applicable- Not Working
YesNoNot Applicable- Not Working
TransportationHousingEmploymentSkills TrainingEducationSocial Activities/Recreational ActivitiesLocationCostDisability AccessLanguageOther
Are there any challenges that are stopping you from being more independent that a center for independent living could help with or assistance finding appropriate resources? (mark all that apply within each section)
Keeping my home cleanLiving on my ownCookingEatingBathing/DressingTaking my medicationsLarge Print/BrailleShoppingMoney ManagementSafetyOther
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 activitiesFinding hobbies I can doDiscrimination in my communityDiscrimination in my jobGetting a jobShoppingControlling my emotionsFear of acceptanceOther
YesNo
YesNo
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 challenges that are stopping you from being more independent that a center for independent living could help with or assistance finding appropriate resources? (mark all that apply within each section)