We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

COVID Impact Survey for Individuals with Special Needs

COVID Impact Survey Introduction

The Special Needs Advisory Coalition of Palm Beach County (SNAC PBC) is requesting your input to assess the impact of COVID-19 on people with special needs. It is estimated that this survey can be completed in 3-5 minutes. Your participation will help the community to create programs that meet your needs. It is ok if someone helps you complete the survey! If you have any questions regarding this survey, please email info@unicornchildrensfoundation.org or call (561) 620-9377.

4. What is your residential postal zip code? *This question is required.

5. Do you receive Social Security Income (SSI) or Social Security Disability Income (SSDI)?

6. What conditions have you been diagnosed? Please check all that apply. *This question is required.

7. Compared with before the coronavirus pandemic, how isolated do you feel from others now? *This question is required.

8. Pre-COVID, what was your primary activity? Please check all that apply. *This question is required.

Stayed at Home
Received In-Person Individual (1:1) Therapy Sessions
Received In-Person Group Therapy Sessions
Was in school
Attended a day program
Worked part or full-time
Volunteered
Other - Write In Please enter an 'other' value for this selection.

9. How has COVID impacted your life? Please check all that apply. *This question is required.

10. What transportation options are you able to use independently? Please check all that apply. *This question is required.

11. How do you receive COVID-19 information or information on available programs or resources? Please check all that apply. *This question is required.

12. What resources, services, or supports would be helpful for you? Please check all that apply. *This question is required.

13. How do you prefer to receive services or supports? Please check all that apply. *This question is required.

Online/Internet/Computer/SmartPhone
In-Person (1:1)
In-Person (small groups)
Other - Write In Please enter an 'other' value for this selection.

14. What day(s)/time(s) would be best for you to access programs or resources? Please check all that apply.

Space Cell	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning (8am-12pm)	Morning (8am-12pm): Monday	Morning (8am-12pm): Tuesday	Morning (8am-12pm): Wednesday	Morning (8am-12pm): Thursday	Morning (8am-12pm): Friday	Morning (8am-12pm): Saturday	Morning (8am-12pm): Sunday
Afternoon (12pm-5pm)	Afternoon (12pm-5pm): Monday	Afternoon (12pm-5pm): Tuesday	Afternoon (12pm-5pm): Wednesday	Afternoon (12pm-5pm): Thursday	Afternoon (12pm-5pm): Friday	Afternoon (12pm-5pm): Saturday	Afternoon (12pm-5pm): Sunday
Evening (5pm-9pm)	Evening (5pm-9pm): Monday	Evening (5pm-9pm): Tuesday	Evening (5pm-9pm): Wednesday	Evening (5pm-9pm): Thursday	Evening (5pm-9pm): Friday	Evening (5pm-9pm): Saturday	Evening (5pm-9pm): Sunday

15. Is there anything else you would like to share?

17. If you are willing to be contacted about the needs you identified, complete future surveys, or participate in future focus groups? Please provide your name and phone number.

18. If you are willing to be contacted about the needs you identified, complete future surveys, or participate in future focus groups? Please provide email.

Thank you for taking our survey. Your response is very important to us.