Every three years, the Jefferson Area Disability Board (DSB) assesses the needs of people with physical and sensory (hearing, sight, etc.) disabilities in the Thomas Jefferson Planning District (the City of Charlottesville and the Counties of Albemarle, Fluvanna, Greene, Louisa and Nelson).
This information is used to:
If you feel you have a physical and/or sensory disability, please take the time to fill out the following questions. If you only have another type of disability such as an intellectual disability, mental health or substance abuse issues, the agency that covers those services is Region 10 at (434) 972-1800. If you feel that you have both physical/sensory and another type of disability, we welcome your input. You may also fill out the survey for a friend or family member. This survey is also available as a downloadable pdf file (143 KB)
Year of Birth: Gender: Male Female
Highest Level of Education: ( click here if currently enrolled) None Completed Pre-K Kindergarten - 5th grade 6th - 8th grade 9th - 10th grade 11th-12th grade (no diploma) High school diploma or equivalent Some college Associate Degree Bachelor's Degree Postgraduate degree
I live in: Albemarle County City of Charlottesville Fluvanna County Greene County Louisa County Nelson County
Current Living Arrangement: Own house/apt/condo Rent Group Home Nursing Home Parent/Relative/Friend Homeless Other:
Employment Status: Part-Time Full-Time Student Volunteer Retired Unemployed Looking for a job Unable to work
(check the one you most identify with)
Please indicate which of these services you’re currently using:
Please select 5 greatest areas of need and number 1-5, with 1 being most important: (please select all 5)
Are there other services that you feel should be offered that aren’t listed? Please explain:
What do you want to achieve in your future?
What barriers might keep you from reaching your goals?
What do you need to reach your goals?
Please share any other thoughts you have about the needs of people with physical, visual or hearing disabilities and available services in our region.
Contact Information (optional)
