EWC Feedback
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1. Everywoman's Center
1
. I am a
I am a
UMass undergraduate student
UMass graduate student
UMass staff/faculty
Five College member
Hampshire County community member
Teen (ages 13 - 17)
Human Service Provider
Other (please specify)
2
. I am providing feedback on the following service
I am providing feedback on the following service
EWC mainline 545-0883 and/or Wilder Hall lounge/reception
Rape crisis services/counseling/advocacy (24 hotline)
General counseling services
Educational workshop
Teen Services
An EWC event
An EWC support group
EWC main webpage
MyCenter webpage
Email correspondence
3
. My Gender is
My Gender is
Female
Male
Transgender
Other (please specify)
4
. How do you identify your Race/Ethnicity? Please check all that apply.
How do you identify your Race/Ethnicity? Please check all that apply.
American Indian or Native American
Asian, South Asian, Asian American, or Pacific Islander
Black, African, or African American
Caucasian, White or European-American
Latina/o, Chicana/o, or Hispanic
Multiracial
Other (please specify)
5
. Please identify any challenges/disabilities you may have. Please check all that apply.
Please identify any challenges/disabilities you may have. Please check all that apply.
Mobility impairment
Visual impairment
Hearing impairment
Mental health/psychological
Developmental/learning
Substance abuse
Other (please specify)
6
. How did you hear about EWC?
How did you hear about EWC?
Brochure
Workshop
Event
Friend
Website
Email
Other (please specify)
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