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Yes ICAN needs your help. Our goal is to provide you with confidential support and resources to help promote your safety and healing. Your responses to the following questions can help us continue our work and ensure that we are providing you with the best possible assistance. Please be assured that your answers are ENTIRELY CONFIDENTIAL and WILL NOT be shared. You are free to answer as many or as few of the questions as you feel comfortable. Thank you for helping us help you.

1. What brought you to Yes ICAN today?

2. What services did you receive at Yes ICAN today? (Check all that apply)

3. How helpful did you find your visit today?

4. Are there ways in which Yes ICAN could provide additional help? Please explain.

5. What is your zip code? (This information will be used for funding purposes only and will NEVER be shared or traced to any individuals).

6. What is your age?

7. What is your annual household income?

8. Why did you choose Yes ICAN today instead of other resources?

9. For how long have you been using the Yes ICAN website?

10. We would like to check in with you and see how you are doing in six months with another survey? Would you be willing to provide your email address below so we can send you a reminder?

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