Survey

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Please fill out the following form. The summary should only take you about five minutes:

1. Please identify your role (check one)

Please identify your role (check one) SEA Part B

Section 619

Lead Agency Part C

Provider Part C

LEA Provider

Parent Organization

Parent

RRC

TA&D Project

Other (please specify)

2. Please rate your level of agreement with the following statements.

	Disagree 1	2	3	4	5	Agree 6	Not Applicable
Overall, the information that was shared met my expectations for this event.	Please rate your level of agreement with the following statements. Overall, the information that was shared met my expectations for this event. Disagree 1	Overall, the information that was shared met my expectations for this event. 2	Overall, the information that was shared met my expectations for this event. 3	Overall, the information that was shared met my expectations for this event. 4	Overall, the information that was shared met my expectations for this event. 5	Overall, the information that was shared met my expectations for this event. Agree 6	Overall, the information that was shared met my expectations for this event. Not Applicable
I received new information about data sharing between Part C and Section 619.	I received new information about data sharing between Part C and Section 619. Disagree 1	I received new information about data sharing between Part C and Section 619. 2	I received new information about data sharing between Part C and Section 619. 3	I received new information about data sharing between Part C and Section 619. 4	I received new information about data sharing between Part C and Section 619. 5	I received new information about data sharing between Part C and Section 619. Agree 6	I received new information about data sharing between Part C and Section 619. Not Applicable
Overall, the event was of high quality.	Overall, the event was of high quality. Disagree 1	Overall, the event was of high quality. 2	Overall, the event was of high quality. 3	Overall, the event was of high quality. 4	Overall, the event was of high quality. 5	Overall, the event was of high quality. Agree 6	Overall, the event was of high quality. Not Applicable
The event was relevant to my work.	The event was relevant to my work. Disagree 1	The event was relevant to my work. 2	The event was relevant to my work. 3	The event was relevant to my work. 4	The event was relevant to my work. 5	The event was relevant to my work. Agree 6	The event was relevant to my work. Not Applicable
The event was timely.	The event was timely. Disagree 1	The event was timely. 2	The event was timely. 3	The event was timely. 4	The event was timely. 5	The event was timely. Agree 6	The event was timely. Not Applicable
The event was useful.	The event was useful. Disagree 1	The event was useful. 2	The event was useful. 3	The event was useful. 4	The event was useful. 5	The event was useful. Agree 6	The event was useful. Not Applicable
The planning for the event was good.	The planning for the event was good. Disagree 1	The planning for the event was good. 2	The planning for the event was good. 3	The planning for the event was good. 4	The planning for the event was good. 5	The planning for the event was good. Agree 6	The planning for the event was good. Not Applicable
Facilitation of the event was high quality.	Facilitation of the event was high quality. Disagree 1	Facilitation of the event was high quality. 2	Facilitation of the event was high quality. 3	Facilitation of the event was high quality. 4	Facilitation of the event was high quality. 5	Facilitation of the event was high quality. Agree 6	Facilitation of the event was high quality. Not Applicable
I had opportunities to ask clarifying questions.	I had opportunities to ask clarifying questions. Disagree 1	I had opportunities to ask clarifying questions. 2	I had opportunities to ask clarifying questions. 3	I had opportunities to ask clarifying questions. 4	I had opportunities to ask clarifying questions. 5	I had opportunities to ask clarifying questions. Agree 6	I had opportunities to ask clarifying questions. Not Applicable

3. How would you rate the utility of the information?

How would you rate the utility of the information? 1

4. Describe how you might use the information you received.

Describe how you might use the information you received.

5. How will your participation in the event enhance your ability to serve children and families?

How will your participation in the event enhance your ability to serve children and families?

6. Do you have any follow-up requests?

Do you have any follow-up requests?

7. Please suggest improvements for future events.

Please suggest improvements for future events.

8. Additional comments:

Additional comments:

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