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Jean Wolff-Rossi Fund for Participant Involvement
(Rossi Fund) Participant Survey Form

Welcome home! Please fill out this questionnaire and then complete your Rossi Fund Reimbursement Form. The information you provide will help us to improve the Jean Wolff-Rossi Fund for Participant Involvement process in the future.

*Your Name: Today's Date:
*Your Email:
Name of Event*: Date of Event*:
1. Did this event improve your knowledge, networking, or skills to be a better
    self-advocate and/or to improve the lives of people with developmental disabilities?
         Yes    Maybe    No

2. Would you recommend this event to someone else?
         Yes    Maybe    No

3. What will you do with what you learned at this event?
4. How did you find out about the Rossi Fund? (Check one)
     Brochure NCCDD Website Local Organization/Agency Friend/Relative
  Other:
5. How can we make the Rossi Fund better?
6. Anything else you want us to know?
7. May we use your comments about the Rossi Fund in NC Council on
    Developmental Disabilities publications or on the Council website?
     Yes    No

Thank you for filling out this survey on the Jean Wolff-Rossi Fund for Participant Involvement. We will use the information you have provided along with other responses to make our program more accessible to family members of and individuals with developmental disabilities. If you would like to provide additional feedback, need assistance, or have questions about this survey please contact:

Rossi Fund Coordinator
NC Council on Developmental Disabilities
3125 Poplarwood Court, Ste. 200
Raleigh, NC 27604
EMAIL: RossiFund@nccdd.org
FAX: (919) 850-2915
PHONE: 1-800-357-6916, (919) 850-2901

Click the button below if you would like to print a copy of your survey responses before submitting.
SUBMIT SURVEY (form will clear with each submission)