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ADA Survey 2017

  1. The Village of Niles is seeking input from agencies, organizations and individuals with disabilities to help the Village enhance accessibility to its facilities, programs, services and events.

    Please respond to the following questions.

  2. 1. What is your relationship to the Village of Niles?

    (Check all that apply)

  3. 2. Check all programs, services or activities in which you participate at the facility, site or location:

  4. 3. Do you know who to contact if you need assistance, have a concern or complaint, or need an accommodation to access a facility, service or event?

  5. 4. Have you ever requested an accommodation for a disability from the Village?

  6. 5. If an accommodation was requested, was your accommodation made by the Village?

  7. 6. Have you experienced any barriers, nonaccessible areas, or nonaccessible programs?

    (Examples: no accessible parking spaces, difficulty reaching an accessible entrance, steep ramps, uneven sidewalks, need for assistive listening device, large print, etc.)

  8. 7. Have you attended any special events in the Village?

  9. 8. Is accessible seating provided for individuals with disabilities at meetings, classes, programs, etc. held at the facility?

  10. 9. Are you aware of any programs, services or activities that are not accessible to individuals with disabilities?

  11. 10. Are you aware of any areas or elements of the facility that are not accessible to individuals with disabilities?

  12. 11. Is information provided regarding accommodations and auxiliary aids (such as assistive listening systems, interpreters, alternate formats, specialized equipment, or assisted services, etc.?)

  13. 12. Is there adequate directional and informational signage provided at the facility?

  14. 13. If you have requested auxiliary aids, an interpreter or specialized equipment, was your request accommodated?

  15. 14. Has the attitude of the staff of the Village of Niles towards you or someone you know with a disability been generally helpful, supportive, positive and proactive in solving accessibility issues?

  16. Thank you for your input!

  17. Leave This Blank:

  18. This field is not part of the form submission.