MHAC Reference Manual
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This survey is to help the MHAC for the KIPDA Region determine the effectiveness of the Reference-Resource Manual you recently received.
Organization Type: ______________________________________
Month and year you received the Reference & Resource Manual: ______________________________
Have you requested or received additional copies? ________
If yes to #3, how many? _____________
How many staff at your organization have access to the manual? _____________
Did you find the manual easy to use? (please circle)
1 - not at all
2 - somewhat
3 - neutral
4 - easy
5 - very easy
Did your knowledge of how to work with older adults improve after reading the manual? (please circle)
1 - not at all
2 - somewhat
3 - neutral
4 - a lot
5 - very much
Briefly, what have you learned? ___________________________

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How can we improve the manual? ____________________________

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Completing Survey: on line___________ by mail __________
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