Grassroots Self-Advocate Questionnaire

Hello!

We’d love to know a little more about you. Please respond to as many questions as you feel comfortable answering. Your responses will help us to better understand you and your amazing story!

Please only answer the questions in the final section if you are a veteran.

If you prefer to complete this as a handwritten form, please download and print this PDF, write your responses, then scan and submit it to Advocacy@SourceAmerica.org.

Background

First Name *

Last Name *

Pronouns

Home Address *

Home Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Home/Cell Phone Number *

Email Address

Position/Job Title *

Length of Employment *

Supervisor Name *

Supervisor Email *

Supervisor Phone *

About You

Do you identify as a person with a disability? If so, what has been your experience as a person with a disability in the workforce?

Life with Your AbilityOne Job

What does a typical day in your job look like? How would you describe your job? What is your favorite part of your job? What do you look forward to when you go to work each day?

What personal goals have you been able to achieve or hope to achieve through this position (living arrangements, transportation, financial stability, etc.)? In particular, has your job given you more independence and what has it enabled you to do?

Have you earned a promotion or a raise in your career? If so, when, and what did that mean to you?

What does your AbilityOne job mean to you? Why is it important?

Can you tell us about your nonprofit agency and what it has meant to work with them? What has that experience been like and how have they helped you or empowered you?

Life Before Getting Your AbilityOne Job

How difficult was it to find a job? What was your job search like?

How did you get your AbilityOne job and how did that change your life experience?

The Future/Advocacy

What do you wish people knew about employing people with disabilities?

What do you want other people to know about your job and the work that you do?

In what ways have you learned to be an advocate for yourself and for others? What have you learned from those experiences?

Are You a Veteran or a Veteran with a Disability?

Yes or No *

What was your role?

Can you describe your military experience and what it means to you?

Do you have a community of veterans that you are connected to at work? What does that mean to you?

If you are a veteran with a disability, is your disability related to your time in the service? How has it impacted you?

What do you think is the greatest challenge for veterans with disabilities finding employment?