Questionnaire

In which language do you prefer to communicate?

EnglishSpanishOther (if other, please specify)

Preferred Language (Other)

Do you have a long-lasting or chronic condition (such as physical, visual, auditory, cognitive, emotional, or other condition) that requires ongoing accommodations for you to conduct daily life activities (such as your ability to see, hear, move, speak, learn, remember or concentrate)?

YesNo

Prefer not to say

Prefer to self describe (with comment box below)

Do you identify as a member of the LGBTQIA+ community?

YesNoPrefer not to sayPrefer to self describe (with comment box below)

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