Community Needs Survey

We value your suggestions for improving vocational rehabilitation services for West Virginians. By thoughtfully answering the following questions, you can help us to get West Virginia working more effectively for a better future.

If you need to speak with someone about services for yourself, a family member or friend, use the Information Request form to provide us with your contact information.

If you complete this survey or an Information Request, please don't forget to click the "Send" button after answering the questions. We appreciate your help.

1. Please choose the response that best applies to you
   (Select all that apply)
   
   I am … an individual with a disability
   in need of services to obtain or retain employment
   a parent or family member of a person with disabilities
   an advocate for persons with disabilities
   a service provider
   a rehabilitation professional
   a vocational rehabilitation counselor
   a school counselor
   Other (please explain below)
   
   (If your answer above was "Other," please specify)
2. What services are needed by persons with disabilities?
    
3. In which West Virginia counties are the services needed?
   (Select all counties in which you have a specific interest and knowledge of the need)
   

   Barbour	Berkeley	Boone	Braxton	Brooke
   Cabell	Calhoun	Clay	Doddridge	Fayette
   Gilmer	Grant	Greenbrier	Hampshire	Hancock
   Hardy	Harrison	Jackson	Jefferson	Kanawha
   Lewis	Lincoln	Logan	Marion	Marshall
   Mason	McDowell	Mercer	Mineral	Mingo
   Monongalia	Monroe	Morgan	Nicholas	Ohio
   Pendleton	Pleasants	Pocahontas	Preston	Putnam
   Raleigh	Randolph	Ritchie	Roane	Summers
   Taylor	Tucker	Tyler	Upshur	Wayne
   Webster	Wetzel	Wirt	Wood	Wyoming

   
    
4. Please identify the race/ethnicity of the individual who needs services
   (Select any or all with which the individual identifies)
   White
   Asian
   Black or African American
   Native American
   Native Hawaiian or Pacific Islander
   Hispanic
   Other (please specify below)
   
   (If your answer above was "Other," please specify)
    
5. What is the age of the individual who needs the services?
    
6. Your phone number (only if you want to request services)
    
7. Your email address (only if you want to request services)
    

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