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This needs assessment is designed to gather information that will better help us in providing programs and services for people with disabilities within the community. Any information provided is confidential and will only be used to determine programming and services needed to better serve the community.
Who is completing this needs assessment?*
1. Participant
2. Parent/Guardian
3. Professional (e.g. teacher, instructional aide, support staff)
4. Other
If Other, please specify:
Participant Information
Name*
Email Address*
Address*
City*
State*
Zip Code*
Phone Number*
How do you prefer to receive information about programs and/or services?*
Please mark all that apply
1. Email
2. Mail
3. Paper Flyers at Offices or Events
1. Activity Guide
2. CSD Website
3. Social Media (e.g. Facebook, Twitter)
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What type(s) of Accommodations or Support Services are you interested in requesting?
Please mark all that apply
1. 1:1 support provided by CSD staff
2. 1:1 support provided by personal aid and/or family member
3. Age Override
4. Assisted device(s) provided by CSD
5. Interpretation Services
Please note that 1:1 support services provided by CSD staff may not be available for all programs. Reasonable accommodations are determined on an individual basis.
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If you would like to contact staff to further discuss this needs assessment or the Recreation ADventures program, please call (916) 405-5600 or send an email to CieraDulgar@csdparks.com

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