Consumer Involvement Fund (CIF) Organization Application Survey

    Please take a few moments to complete our survey related to utilizing the Consumer Involvement Fund (CIF). Your response(s) will help us address the needs of people with developmental disabilities and their family members. Your survey and responses will help us achieve our goal of providing financial assistance to Alabamians with developmental disabilities in helping enhance, promote, and support independence, advocacy, productivity, and inclusion. Rate your knowledge of one or more of the following items listed below before attending the requested conference. Thank you for your valuable input. Alternate formats are available upon request. (Please use the translation option at the bottom of this page to translate this information into other languages as needed.)


    For the following: 1 = Not Very Much - 5 = A Lot


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    YesNo



    YesNo



    Less than five hoursSix to 10 hoursMore than 10 hoursOther




    YesNo


    Demographic Information of Individuals Using the CIF


    CaucasianAfrican AmericanHispanicNative AmericanAsianOther


    I am a person with a developmental disabilityI am a parent of a child with a developmental disabilityI am the guardian of a person with a developmental disabilityMy family member is an adult with a developmental disability


    MaleFemaleOther


    I am a Resident of an Urban Area (More than 50,000 people live there)I am a Resident of a Rural Area (Less than 50,000 people live there)

    What conference or event are you seeking funds to attend?

    Note: Please provide any information on the event that clearly explains what you want to attend, such as the agenda, brochure, and/or flyer.

    Please indicate funds below.

    HOW MUCH CAN YOUR ORGANIZATION PAY (YOUR FUNDS)? HOW MUCH FUNDED BY OTHERS (OTHER AGENCIES)? HOW MUCH REQUESTED FUNDS (FUNDING FROM ACDD CIF)?