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  Needs Assessment: Dear Farm/Ranch Family with a Disability

   

July 17 , 2006

Dear farm/ranch family with a disability,

Thank you for taking the time to tell me what information and education you need. Would you please check the number below each topic to indicate how interested you are in the topic? When you are finished, click the "submit" button to send me your form.

1)  Success stories from satisfied Colorado AgrAbility farmers/ranchers
     Not Interested                       Very Interested
   
2)  Guest speakers, e.g. satisfied Colorado AgrAbility ranchers/farmers
  Not Interested                       Very Interested
   
3)  Care giving skills for myself and for my family
  Not Interested                       Very Interested
   
4)  Neighbor-to-Neighbor Support volunteer training to be a support to someone with a new disability
  Not Interested                       Very Interested
   
5)  Recent technology innovations for farmers and ranchers-low and high tech
  Not Interested                       Very Interested
   
6)  Ranch/Farm safety
  Not Interested                       Very Interested
   
7)  Ideas for improving accessibility in the home
  Not Interested                       Very Interested
   
8)  Ideas for improving accessibility on the farm/ranch
  Not Interested                       Very Interested
   
9)  Arthritis and ranching/farming
  Not Interested                       Very Interested
   
10)  Back impairments and farming/ranching
  Not Interested                       Very Interested
   
11)  Estate planning to get your ranch/farm to your heirs with minimal tax
  Not Interested                       Very Interested
   
12)  Getting what you're entitled to from Medicare and Medicaid
  Not Interested                       Very Interested
   
13)  Getting what you're entitled to from Social Security, Social Security Disability, etc.
  Not Interested                       Very Interested
   
14)  Ticket to Work, Pass (Plan for Achieving Self Sufficiency) plan training to purchase equipment, livestock, land, vehicles, etc.
  Not Interested                       Very Interested
   
15)  Maximizing and using all the tax-deductible items available to you, e.g. mileage to visit the physician
  Not Interested                       Very Interested
   
16)  Sources of grant money for buying assistive technology
  Not Interested                       Very Interested
   
17)  Ways you could help change the system to get more money for ranchers/farmers with disabilities, e.g. write/call senator, congressional representative, etc.
  Not Interested                       Very Interested
   
18)  Internet Web Sites with credible information
  Not Interested                       Very Interested
   
Other (optional):
  Not Interested                       Very Interested
   
Who are you (check all that apply)?
  A farmer/rancher with a disability/impairment
  A caregiver of a rancher/farmer with a disability/impairment
  A professional who works with farmers and ranchers with disabilities
  A Colorado State Cooperative Extension Agent
  Other (please specify)
   
 
   
Thank you very much! We'll use your information to plan even better AgrAbility workshops for next year.
   
Sincerely,

Robert J. Fetsch
Extension Specialist,
Human Development & Family Studies