Parishioner Disability Survey

Holy Name of Jesus is currently participating in the National Catholic Partnership on Disability mentorship program, to help our church be a place where all our parishioners with disabilities and their families feel welcomes, valued and safe.

This brief survey will help us to better understand and address the needs of those within our parish to ensure they can participate fully in all the church offers. This survey is anonymous, but an optional place to give your name and phone number if you wish to be called to speak further about your or your loved one’s needs. Thank You and God Bless!

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1. Which best describes your or your family member's disability? Check all that apply. *

• Physical
• Mental Health
• Sensory (deafness, blindness)
• Intellectual/Developmental
• Autism Spectrum
• Dementia
• Other (please explain below)

If "Other", please explain:

2. What is the age range of your individual with a disability? *

• under 15 years
• 15-21 years
• 22-40 years
• 41-60 years
• over 60 years

3. Is the Holy Name of Jesus Church building accessible? *

• Yes
• No

If no, please explain:

4. Are there barriers to you or your loved one participating in Mass? *

• Yes
• No

If yes, please explain:

feel Would If

5. Would it be helpful for HNJ to provide the following accessible formats?

• Braille
• Large Print
• Audio Devices

6. What activities would help you or your loved one with a disability feel a true sense of belonging to our parish community? *

• Sensory Mass
• Social Activities (age appropriate)
• Volunteer Opportunities at Church
• Adapted Sacramental Preparation
• Other (please explain below)

If "Other", please explain:

7. On a scale of 1-5 (1=very inclusive, 5=not inclusive), how inclusive do your feel our parish culture is toward those with disabilities? *

• 1
• 2
• 3
• 4
• 5

8. Would you feel comfortable discussing the needs with a person in church leadership, so we could fully understand how to help? *

• Yes
• No

If yes, please fill in your contact information and someone will call you soon.

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