1. What would you like MPAS to work toward this year?

2. What issues are you trying to overcome on a daily basis?

3. What areas do we do well that you would like us to continue?

4. What areas do we need to improve?

Optional (but helpful to us)
Check all that apply

I am a:

Person with a developmental disability

Person with a disability that occurred after I was 22 years old

Person labeled mentally ill

Person labeled emotionally disturbed

Person with a traumatic brain injury or closed head injury

Person living with HIV

Person living with AIDS

Family member of a person with a developmental disability

Family member of a person labeled mentally ill

Family member of a person labeled emotionally disturbed

Family member of a person with a disability occurring after they were 22 years old

Ethnic Background:

Caucasian

African American

Arab or Chaldean American

Hispanic American

Native American

Asian or Pacific Island American

Other

Geographic Location:

Please select the county you live in:

Alcona Alger Allegan Alpena Antrim Arenac Baraga BarryBayBenzieBerrienBranchCalhounCassCharlevoixCheboyganChippewaClareClintonCrawfordDeltaDickinsonEatonEmmetGeneseeGladwinGogebicGrand TraverseGratiotHillsdaleHoughtonHuronInghamIoniaIoscoIronIsabellaJacksonKalamazooKalkaskaKentKeweenawLakeLapeerLeelanauLenaweeLivingstonLuceMackinacMacombManisteeMarquetteMasonMecostaMenomineeMidlandMissaukeeMonroeMontcalmMontmorencyMuskegonNewaygoOaklandOceanaOgemawOntonagonOsceolaOscodaOtsegoOttawaPresque IsleRoscommonSt. ClairSt. JosephSaginawSanilacSchoolcraftShiawasseeTuscolaVan BurenWashtenawWayneWexford

EmploymentStatus:

I am	Employed
	Unemployed
	Retired
Looking for employment
	Not looking for employment