Institutions That You Are Most Concerned About Across The United States Survey

People First of New Hampshire's #1 goal is to help close institutions across the country. Members are wanting to know ways that they can be helpful and supportive. Please complete the survey to help us collect information about state and private institutions across the United States that you are most concerned about.* For multiple institutions within the state, we've allowed space for you to list up to 3 (choose the top 3 you are most concerned about.)**

Our email address for questions or comments is: info@peoplefirstofnh.org. Please use subject line "Institution Survey".

We have extended the deadline to complete the survey to February 19. Pass the link of this survey along to anyone else you think might like to respond (http://www.surveymonkey.com/s/C3B65VL). Once the survey responses have been collected, we will share the results on our webpage and our board of directors will make decisions about how People First of New Hampshire can be most helpful based on your information that you submit in the survey.

*Please indicate the name of an institution rather than typing "all of them" It is important to be specific. **You do not need to repeat the same institution. Please type it only once.

Thank you for your time.

People First of New Hampshire
4 Park Street, Suite 205
Concord, NH 03301
603-568-2128
info@peoplefirstofnh.org
www.peoplefirstofnh.org

Please complete your contact information. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

Tell us the name of the first institution you are most concerned about and the location. Please name a specific institution and do not type "all of them". Name of Institution
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:

Tell us the name of the second institution you are most concerned about and the location. Please do not repeat what you've already typed above. Name of Institution
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:

Tell us the name of the third institution you are most concerned about and the location. Please do not repeat what you've already typed above. Name of Institution
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:

1. Please complete your contact information.

2. Tell us the name of the first institution you are most concerned about and the location. Please name a specific institution and do not type "all of them".

3. Is this institution operated by the state or is it private?

4. Tell us what is of most concern to you so that we can focus our attention (we assume you'd like the place to close, but please be more specific).

5. Do you have a family member or friend who lives at this institution? If yes, continue in the comments section.

6. People First of New Hampshire's #1 Goal is to help close institutions across the country. Tell us how we can help.

7. Tell us the name of the second institution you are most concerned about and the location. Please do not repeat what you've already typed above.

8. Is this institution operated by the state or is it private?

9. Tell us what is of most concern to you so that we can focus our attention (we assume you'd like the place to close, but please be more specific).

10. Do you have a family member or friend who lives at this institution? If yes, continue in the comments section.

11. People First of New Hampshire's #1 Goal is to help close institutions across the country. Tell us how we can help.

12. Tell us the name of the third institution you are most concerned about and the location. Please do not repeat what you've already typed above.

13. Is this institution operated by the state or is it private?

14. Tell us what is of most concern to you so that we can focus our attention (we assume you'd like the place to close, but please be more specific).

15. Do you have a family member or friend who lives at this institution? If yes, continue in the comments section.

16. People First of New Hampshire's #1 Goal is to help close institutions across the country. Tell us how we can help.

17. Please copy, paste and send the link of this survey onto others. http://www.surveymonkey.com/s/C3B65VL

Thank you for your time in completing our survey.
If you have any feedback, please share.