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How old are you?
 
18-24
 
25-32
 
33-50
 
51+
 
No answer
 
 
 
How old is your child with Down syndrome?
   
 
 
 
What is the race of your child?
 
White or Caucasian
 
Black or African American
 
Asian
 
Native American or Alaskan Native
 
Native Hawaiian or other Pacific Islander
 
Mixed Race
 
Refuse to Answer
 
Other
 
 
 
 
What is the gender of your child?
 
Male
 
Female
 
Refuse to Answer
 
Other
 
 
 
 
What is the maximum level of education completed by at least one parent in the household?
 
No high school diploma or GED
 
High school diploma or GED
 
Some college/ Associate's degree
 
Bachelor's degree
 
Master's degree
 
Doctoral degree
 
No Answer
 
 
 
What is the level of income for the household?
 
$0-$9,999
 
$10,000-$29,999
 
$30,000-$49,999
 
$50,000-$74,999
 
$75,000-$99,000
 
$100,000 and above
 
No answer
 
 
 
Did your child receive Early Intervention services prior to his/her third birthday?
 
Yes
 
No
 
Don't Know
 
 
 
How long did your child receive Early Intervention services from birth until three years of age?
 
Less than 1 year
 
1-2 years
 
2-3 years
 
No answer
 
 
 
What form of therapies did your child receive in Early Intervention? (Check all that apply)
 
Physical Therapy
 
Occupational Therapy
 
Speech Therapy
 
Specialized Instruction
 
Aquatic Therapy
 
Behavioral Therapy
 
Play Therapy
 
Sensory Therapy
 
Respiratory Therapy
 
Feeding Therapy
 
Therapeutic Listening
 
Vision Therapy
 
Other
 

 
 
 
How many hours per week did your child spend attending all therapy sessions combined in Early Intervention (birth to 3)?
   
 
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