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Community Inclusion Survey
Community Inclusion Survey
Community Inclusion Survey
Step
1
of
4
- About you
25%
About you
Do you wish to enter the prize draw for a $50 gift voucher?
*
Yes
No
3 winners will be drawn at random from survey entries and notified via email by the 22nd January 2021. Completion of the survey is necessary to enter the draw.
Name
*
First
Last
Email
*
Gender
Male
Female
I do not want to answer
How old are you?
What language do you speak at home?
English
Are you an Aboriginal or Torres Strait Islander?
Yes
No
I do not want to answer this question
What is your postcode?
Where do you live?
*
In a private home. For e.g. with your family
Supported Independent Living
Tell us about your disability
Acquired or traumatic brain injury
Autism
Sensory
Physical
Intellectual
Specific communication needs
Other
Write about your disability here.
Do you have multiple and complex support needs?
Yes I have multiple and complex support needs.
No I do not have multiple and complex support needs.
I don't know
Multiple means you have more than 1 disability. For example, communication and physical. Complex means you need a lot of support to do things. For e.g. help to eat.
About your sports and activities
Does your age make it hard for you to play sport or other activities?
Yes
No
Sometimes
Do you use a mobility aid to play sport or do activities?
Yes
No
Sometimes
What mobility aid do you use?
Wheelchair
Scooter
Walking frame
Other
Write what the mobility aid is here
Do you have a service provider?
Yes
No
Who is your service provider?
Who helps pay for your sports and activities?
*
NDIS
TAC
Myself
Do you get help to pay for support to play sport or do activities? For example, a support worker.
*
Yes
No
Write about your support here
Do you get help to pay for fees to play sport?
*
Yes
No
Fees are the money you pay to a club or team so you can play sport with them.
Write about the helps you pay for sport here.
About the sports you play now
What organised sports do you play now?
Balloon football
Balloon netball
Ice sports
Boccia
Wheelchair soccer
Wheelchair football
Wheelchair basketball
Wheelchair rugby
I do not play organised sport
Why do you like to play organised sports?
I like the competition
I like to learn new skills
I like to be part of a team
I like to play with friends
I like to feel part of my community
I like to stay active and healthy
It makes me feel happy when I play sport
Other
Write about why you like to play sport here
Who helped you start to play sport?
By myself or family
Scope Community Inclusion
My service provider
Supported independent living
My support coordinator
My therapist
My NDIA planner or LAC
School
Sports club
Other
Write about who helped you start to play sport here
About your other activities
What recreational activities do you do now?
I swim
I walk
I surf
I go fishing
I work in my garden
I go to the gym
I ride my bike
Other
Recreational activities means things you do to stay healthy and active. You can tick more than one box.
Write about the other activities you do here.
What do you like about your activities instead of doing organised sport?
I like to do my own thing
I like to be out in my community
I like to be able to do the activity whenever I feel like it
My activity can not be done as an organised sport
Other
Write your other reason here
Who helped you start your recreational activity?
By myself or family
Scope Community Inclusion
My service provider
Supported independent living
My support coordinator
My therapist
My NDIA planner or LAC
School
Sports club
Other
Write about who helped you start to play sport here.
Are there sports or activities you would like to start doing?
Yes
No
I do not know
Write about the sports or activities you would like to start doing here.
If you do not do sports or activities
Why do you not do any sports or activities?
I do not like sport
There are no sports or activities near me
I can not pay for sports or activities
I do not get support to do sports or activities
It is too far to travel
Sports or activities are not accessible
I do not know what sports or activities I could do
Other
Write about other reasons here.
Are there sports or activities you would like to start doing?
Yes
No
I do not know
Write about the sports or activities you would like to start doing here.
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