Kingdom Church Needs Assessment - Support for Families of Special Needs Children
This survey is designed to help the Kingdom Church community more clearly understand how it can support children with special needs (e.g., disabilities, learning or developmental differences) and their families.  If you have filled out the paper version of this survey, please do not complete this version.  
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What is your name?
This question is optional
What is your gender? *
Please choose one answer.
Which Kingdom Church location do you most frequently attend? *
Please choose one answer.
What is your marital status? *
Please choose one answer.
What is your age range? *
Please choose one answer.
How would you describe your attendance at Kingdom Church?
Please choose one answer.
Clear selection
Do you have a child/children that attend Kingdom Church? *
Please choose one answer.
If yes, how old is/are your child/children?  
Does your child/children have special needs (e.g., diagnosed disabilities, receive special education services)? *
Please choose one answer.
If yes, would you be willing to share the identified needs and your child's/children's names?
This question is optional
On scale of 1-5, please indicate your level of agreement with the following statement:  Kingdom Church is welcome and receptive to families of children with special needs
Please elaborate on your reason for answering the prior question as you did.
On a scale of 1-5, please indicate your level of agreement with the following statement:  Kingdom Church's children/youth ministry is knowledgeable on how to engage with children with special needs
Please elaborate on your reason for answering the prior question as you did.  
What do you most appreciate about how Kingdom Church's children/youth ministry engages your child(ren)?
What specific supports are needed - in general - at Kingdom Church to meet the needs of children with special needs and their families?
What specific supports are needed - specifically - within Kingdom Church's children and youth ministry to meet the needs of children with special needs and their families?
Please share where or from whom you would seek services and support for a child who has a disability at Kingdom Church
Choose all that may apply, if applicable
Clear selection
Please share where or from whom you would seek services and support for a child who has special needs in the community
Choose all that may apply, if applicable
Clear selection
On a scale of 1-5, rate your familiarity with the following term:  Individualized Education Plan (IEP)
On a scale of 1-5, rate your familiarity with the following term:  504 Plan
On a scale of 1-5, rate your familiarity with the following term:  Child Study Team
On a scale of 1-5, rate your familiarity with the following term: Intervention & Referral Services (I &RS)
If you are the parent of a child/children with special needs, what kind of support, if any, do you need?
Would you be willing to support families of children with special needs at Kingdom Church?  If so, would you share name and a way we can contact you moving forward?
What additional information would you like to share about this topic?
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