Peer Support Group Survey It is very important to Peer Support and March of Dimes Canada to improve our services to our Support Groups and their members. To help us improve our services We need information that only you can provide. The information you provide Will be confidential

Information from the surveys will be presented in summary form only. The survey is voluntary and your responses will help improve services for peer support groups across Ontario. We look forward to learning what you think about the March of Dimes Canada peer support program. About you Name: _________________________ Address: _____________________________ Phone: ___________ email: ______________ Name of Support Group: _____________________________________

1. How often does your support group meet? More than once a month Once a month Once a week Every 3 to 6 months Other: _____________________ 2. How Often do you come to group meetings? Less than half Approximately one half More than one half Other:____________________________ 3. How often do you think your support group should meet? More than once a month Once a month Every other month Every 3 to 6 months Other: ____________________

4. How long does it take you to travel to the location of your support group meeting? Less than 15 minutes 15 to 30 minutes 30 to 60 minutes More than 60 minutes 5. What difficulties do you face in going to support group meetings? Distance Transit Fatigue Communication Other:______________________ 6. My support group has made a significant difference in my life. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

7. What are the main reasons you go to support group meetings? Peer Support / Socialization Current events / Announcements Guest Speakers Information / Education Other:________________________ 8. What activities do you enjoy the most at support group meetings? Peer Support / Socialization Current Events / Announcements Guest Speakers Information / Education Conversation and Discussion Other:_______________________

9. Which of the following activities are provided by your support group? (check all that apply) Education Socialization and Conversation Fundraising Hosting conference(s) Guest speakers Community awareness/visitation Daytrips/Excursions Other: ______________________ Are there activities you would like to have offered that are not currently provided by your support group? Leadership training Supportive Communication Training / Education Community awareness/visitation Daytrips/Excursions Other: ______________________

What have you found most helpful about your support group? Peer Support Current Events / Announcements Guest Speakers / Education Reading / Writing practice Opportunity for Conversation Other:________________________ 13. What have you found least helpful about your support group? Peer Support Current Events / Announcements Guest Speakers / Education Reading / Writing opportunities Group size ( too big or too small) Opportunity for conversation Other:__________________________

Would you be interested in Volunteering with this Peer support group Would you be interested in Volunteering with this Peer support group? Please check any positions that interest you: Chairperson Vice Chair Secretary Treasurer Key Worder /Communication Facilitator Preparing Refreshments Other:______________

Now we would like to ask you about March of Dimes Canada and the support and/or services it provides to your support group. 15. Do you feel Peer Support/March of Dimes Canada meets the needs of your support group? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Don’t know Which of the following services offered by March of Dimes Canada are you aware of? DesignAbility® Aphasia Camp Warmline Peer Support Travel Walk and Roll Highlights Publication Aphasia /Communication Program Other: ______________________

to complete this survey. Your information will help us to How could Peer Support/March of Dimes Canada better prepare you to serve your group’s needs? Leadership training Key wording Training / Education Community awareness/visitation Daytrips/Excursions Other: ______________________ 18. I am interested in receiving more information about the programs and services offered. Yes No Thank you for agreeing to complete this survey. Your information will help us to improve your support group experience.