Self Advocate Survey 2011

If you’d prefer to complete this survey online, please go to:

  1. What is your current employment status?

Employed in the community Employed in a sheltered workshop

Self-Employed Not currently employed, but interested in getting a job

Not currently employed and not currently desiring employment
  1. If you are working, where did you go to get help with your job search?

If you are not working, where would you go if you wanted to look for a job? Check all that apply.

People I know (friends, family, etc.) Vocational Rehabilitation
Missouri Career Centers Job Fairs
Newspapers Independent Living Center
Community Provider Agency I have no idea!
All of the above
other (please specify) .
  1. What are some of the barriers in getting a job? Check all that apply.

Transportation Lack of Experience

Lack of knowledge of how my Benefits (Medicaid, Housing, Food Stamps, SSI) will be affected

Limited Openings/Opportunities Education

Unsure of what job I wantAll of the above

other (please specify) .

  1. What are some of the barriers in keeping a job? Check all that apply.

Transportation Lack of Experience

The impact of work on my benefits (Medicaid, Housing, Food Stamps, SSI, etc)

Employer Expectations Interacting with co-workers/supervisors

Not having appropriate job accommodations Employer not understanding needed accommodations

All of the above

other (please specify) .

  1. Would you be interested in self-employment and owning your own business?

No, just regular employment is fine with me.
Yes and would like more information. My email is: .
  1. What information/trainings would be beneficial in assisting you and other self advocates in finding and keeping a job or reaching your other goals? Check all that apply...

Benefits Planning (How your Medicaid and SSI will be affected) Career Planning

How to explore and find out about jobs that will interest me How to Network with others

Self-employment Advocating with Legislators

Advocating with Community Partners

Other (please specify) .

  1. Are you interested in knowing more about APSE-MO or upcoming APSE-MO training opportunities?

No thanks Yes, my email is: .

Demographic information—This information will be used for the purpose of assisting APSE with planning future training activities.

  1. Age

16-20 21-25 26-30 31-35 36-40

41-45 46-50 51-55 56 or older

  1. City of residence

Thank you for your time! If you complete this survey by December 1, 2011, you will be entered into a drawing for a $25.00 Prepaid Visa Card. If you would like to be included in this drawing, please include your information below. This information will not be shared with or sold to organizations outside of APSE.

Name: Phone: E-mail:

Address: