Facility you are providing information about:

1. Current relationship to the Butte County Office of Education (check all that apply):
   student
   parent
   county office employee
   community member
   visitor to county office
   
2. Check all programs, services or activities in which you participate through the Butte County Office of Education:
   classes
   work (employee)
   work (volunteer)
   meetings
   special events
   other
   
3. Have you ever requested accommodations for disabilities from this facility or the Butte County Office of Education?
   Yes        No

   If yes, what accommodations were made?
   
   

4. Have you experienced any exterior barriers, nonaccessible areas or nonaccessible facilities (no accessible parking spaces, difficulty reaching an accessible entrance, steep ramps, uneven sidewalks, etc.)?
   Yes        No

   If yes, list the barriers
   
   

5. Have you experienced any interior barriers, nonaccessible areas or nonaccessible programs inside the facility (stairs only, narrow doorways, protruding objects in the hallways, lack of assistive devices, lack of interpreters, etc.)?
   Yes        No

   If yes, list the barriers
   
   

6. Is accessible seating provided for individuals with disabilities at this facility?
   Yes        No
   
7. Is there adequate directional and informational signage provided at this facility?
   Yes        No
   
8. Is there adequate personnel available to discuss your request/comments/suggestions at this facility?
   Yes        No
   
9. Check the box that best describes Butte County Office of Education's attitude toward you or someone you know with a disability:
   Good = generally helpful, supportive, positive and proactive in solving accessibility issues.
   Fair = mixed responses, sometimes helpful, facility personnel tends to not understand accessibility issues.
   Poor = generally uncooperative, negative attitude, unwilling to solve accessibility issues.