Skip survey header

Registration Form
Listening Session: Community Input on Priorities for Santa Clara County Disability Affairs Office

The World Institute on Disability will be hosting a Listening Session on Tuesday, August 2, 2022, at 7:00 pm PST, in collaboration with the Office of the County Executive in Santa Clara County, as part of the planning process for launching the Santa Clara County Office on Disability Affairs in 2022.

Our hope is that the Listening Session will create a space that invites individuals with disabilities to provide feedback and perspective based on their lived experiences in the county.  At this session, we will be asking for input to learn and understand priority areas as we aim for a more disability-inclusive Santa Clara County. Our intended outcome is to prioritize the Disability Affairs Office strategy, based on community input.

American Sign Language (ASL) and CART Captioning in English will be provided.

Feel free to reach out with any questions or requests at 

Please complete this form to register to attend the Listening Session on 8/2:
This question requires a valid email address.
3. Where in Santa Clara County do you reside? *This question is required.
4. Would you like to speak at the session and share a priority that is important to you or your family? *This question is required.
5. Do you identify as a person with a disability? *This question is required.
6. What type of disability, generally, do you have? *This question is required.
  • * This question is required.
6. Are you a parent or caregiver of a person with a disability? *This question is required.
7. Please select which of the following best describes your connection to disability: *This question is required.
  • * This question is required.