First Name: Last Name: Email Address: Address: City: State: Zip Code: Individual with disability Family member Other Please check the YES or NO box to tell us your opinion about the following: I (or my family member) was treated with respect during this project. YES NO I (or my family member) have more choice and control as result of this project. YES NO I (or my family member) can do more things in my community as a result of this project YES NO Please check the box that best describes your opinion I am satisfied with this project Stongly Agree Agree Disagree Strongly Disagree My life is better because of this project Strongly Agree Agree Disagree Strongly Disagree What has been helpful or not helpful about this project? Comments: Do not enter anything in this field: