Annual Survey
What is your relationship to San Francisco? Check all that apply.
I live in San Francisco
I work or go to school in San Francisco
I live in the Bay Area and visit San Francisco often
I have no meaningful relationship with San Francisco
Please indicate your level of agreement with the statements below:
I feel welcome at the Disability Cultural Center.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
I got the help I needed to connect to available services for people with disabilities
and/or Deaf people.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
I feel more connected with my identity as a member of the disability and/or Deaf
community, or as an ally.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
I feel more connected with disability and/or Deaf community.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
I had more opportunities to make positive change for the disability and/or Deaf community.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
What are the best days and times for you to come to events (please specify in person or virtual)?
Help us keep the DCC alive, tell our funders why the DCC matters.
Is there anything else you'd like to share with us?
Background and Identities
Race
Indigenous / Native American / American Indian / Alaska Native
Black / African American / African
Asian / Asian American
Latine / Latinx / Hispanic / Latin American
Middle Eastern / North African
Native Hawaiian / Pacific Islander
White / Caucasian / European American
Additional
Prefer not to say
Please specify
Gender (Please select the one that best fits)
Agender
Intersex
Gender Expansive/Nonbinary
Cis Man
Questioning
Trans woman
Trans man
Two Spirit
Cis Woman
Additional
Please specify
Sexual Orientation (Please select the one that best fits)
Asexual/Aromantic/Demisexual
Bisexual/Pansexual
Gay/Lesbian
Queer
Questioning
Straight/Heterosexual
Additional
Please specify
Birth year
How would you describe your finances?
Struggling to make it work
Meeting basic needs
Meeting basic needs with a little extra
Comfortable with some disposable income
Financially thriving with lots to spare
Prefer not to share
Check all conditions that you currently experience
Blind / low vision
Deaf / Hard of Hearing
Chronic Illness (HIV/AIDS, Cancer, MCS, MS, etc.)
Chronic pain
Mobility disability
Intellectual / developmental disability
Learning disability (dyslexia, dyscalculia, dysgraphia, etc.)
Mental health condition (anxiety, depression, schizophrenia, bipolar, PTSD, etc.)
Neurodivergent (ADHD, memory loss, autistic, TBI, OCD, etc.)
Addiction
Large size / fat
Limb difference / amputee
Little person / short stature
Undiagnosed
Additional
Please specify
Which do you identify as? Select all that apply.
I am disabled or have a disability.
I have a medical/mental health/chronic illness condition that impacts my daily living.
I am unsure.
People I am close to are disabled.
I am currently non-disabled.
Additional
Please specify
Please select all that you identify with:
BIPOC (Black, Indigenous, person of color)
LGBTQIA+ (Lesbian, gay, bisexual, transgender, queer, intersex, asexual, plus)
Currently or Formerly Unhoused
Systems Impacted (foster care, medical institutions, incarcerated, etc.)
Physically Isolated (limited in-person interactions)
Transition-Aged Youth
QTBIPOC (queer and/or trans Black, Indigenous, person of color)
Consent to Share Information
Do you agree to the following terms?
The San Francisco Disability Cultural Center, a project of L.C. and Lillie Cox Haven of Hope ("HoH"), works in partnership with the City and County of San Francisco. By submitting this information, you consent to these three entities publicly sharing this information without any personal identifying information. Your name, contact information, and all other potentially identifying information are for HoH and DCC internal use only. This potentially identifying information will never be shared with third parties, unless required by law.
consent
I agree to these terms
No, I don't agree to these terms (This survey is intended for anonymous reporting. Consent is required to submit a response.)
Your Information and Newsletter Sign-up (Optional)
If you would like to share your information so that our staff might follow up, please feel welcomed to do so here.
First Name(s)
Last Name(s)
Phone Number
Email
Please sign me up for the DCC's newsletter and mailing list. You can unsubscribe anytime if it's not your thing.
disabilityculturalcenter.org