Faces of Homelessness Speakers' Bureau presentation

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1. Please enter the name of the organization, school, business or location where you saw the Faces of Homelessness Speakers' Bureau presentation.

Please enter the name of the organization, school, business or location where you saw the Faces of Homelessness Speakers' Bureau presentation.   Organization:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
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2. Please enter the date of the Faces of Homelessness Speakers' Bureau presentation.

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-	Please enter the date of the Faces of Homelessness Speakers' Bureau presentation.   -   Month	/	Day	/	Year

3. Pick the two leading causes of homelessness in the U.S.

Pick the two leading causes of homelessness in the U.S.   a. Drug/Alcohol abuse b. Chosen lifestyle c. Divorce/separation d. Domestic abuse e. Lack of affordable housing f. Medical issues g. Teen pregnancy h. Release from jail/prison i. Job loss or low wages j. Mental illness

4. My family could become homeless.

My family could become homeless.   Yes No

5. Are you now more likely to volunteer and/or support your national and local homeless service providers?

Are you now more likely to volunteer and/or support your national and local homeless service providers?   Yes No

6. Will you speak up if you hear negative comments about the homeless from family, friends or co-workers?

Will you speak up if you hear negative comments about the homeless from family, friends or co-workers?   Yes No

7. Has your perception of homelessness changed? If so, how has it changed?

Has your perception of homelessness changed? If so, how has it changed?

8. How did you hear about this presentation?

How did you hear about this presentation?   Facebook page
Newspaper
Radio
TV
Website
Flier or Brochure
Invited by a Speaker
Speakers' Bureau Coordinator
Other

9. Thank you for taking the time to fill out this survey.

If you are interested in scheduling a presentation by the Faces of Homelessness Speakers' Bureau or volunteering please fill out the information below and we will contact you.

Thank you for taking the time to fill out this survey. If you are interested in scheduling a presentation by the Faces of Homelessness Speakers' Bureau or volunteering please fill out the information below and we will contact you.   Name:
Company:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Email Address:
Phone Number:

10. Additional comments.....

Additional comments.....