Online Forms

2. 
4. Hinton Disabilities Services Assessment
   Agency representatives are asked to please complete this short survey about what our community currently offers for people with disabilities. Agency representatives are also invited to join us for a collaborative meeting on November 12.
6. 1. Which agency do you represent?*
8. 2. Does your agency currently offer services for people with disabilities (cognitive or physical)?*

   1. Yes
   2. No
10. 2. (a) Do services focus on cognitive or physical disabilities?*

    1. Physical
    2. Cognitive
    3. Both
12. 2. (b) Please describe the services for people with disabilities that your agency currently offers:*
14. 3. Would your agency consider offering additional services for people with disabilities? If so, please describe below:*
16. 4. As an agency, please describe any gaps or challenges for supporting people with disabilities in the community:
18. 5. We are hosting a Disabilities Services Community Assessment Session on Thursday, November 12. Is one representative from your agency able to attend this session?*

    1. Yes
    2. No

    Please note: in-person attendance is limited to one person per agency due to COVID-19 space restrictions. Attendees are also invited to attend via Zoom.
    The session details are as follows:
    Thursday, November 12
    6:00 - 8:00 pm
    Northern Rockies Museum of Culture & Heritage (downstairs Meeting Room)
20. Will your agency be attending in-person or through Zoom?

    1. In-Person
    2. Online through Zoom

    If more than one representative would like to attend, additional attendees can join via Zoom.
    Zoom links will be sent out before the meeting.
22. First Name*
23. Last Name*
25. Email Address*
26. Phone Number*
28. 4. Additional Comments
    (please add any additional feedback here)
30. Thank You!
    Thank you for your input. Survey responses will be used to guide our discussion at the Community Assessment Session on November 12. We hope your agency is able to join us for this session.
    If you have any questions, please contact Jenna at jaltrogge@hinton.ca or 780-865-6073
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field