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1. How did you hear about the Connecticut Family Support Network (CTFSN)?

How did you hear about the Connecticut Family Support Network (CTFSN)?

2. Was information provided to you in a timely manner?

Was information provided to you in a timely manner? Yes

No

3. How helpful was the information you received from CTFSN?

	Extremely Helpful	Very Helpful	Helpful	Somewhat Helpful	Not At All Helpful	N/A
Please rate:	*How helpful was the information you received from CTFSN? Please rate: Extremely Helpful	Please rate: Very Helpful	Please rate: Helpful	Please rate: Somewhat Helpful	Please rate: Not At All Helpful	Please rate: N/A

What information was most helpful to you?

4. How likely are you to contact CTFSN in the future?

	Extremely Likely	Very Likely	Likely	Somewhat Likely	Not At All Likely
Please rate:	*How likely are you to contact CTFSN in the future? Please rate: Extremely Likely	Please rate: Very Likely	Please rate: Likely	Please rate: Somewhat Likely	Please rate: Not At All Likely

Why? Or why not?

5. How likely are you to refer another parent to CTFSN?

	Extremely Likely	Very Likely	Likely	Somewhat Likely	Not At All Likely
Please rate:	*How likely are you to refer another parent to CTFSN? Please rate: Extremely Likely	Please rate: Very Likely	Please rate: Likely	Please rate: Somewhat Likely	Please rate: Not At All Likely

Why? Or why not?

6. If you would like to join a CTFSN email distribution list in your region, please provide your email and town. You will receive emails with information on subjects that may include: Special Education, Support Groups, Public Policy and Legislation, How to get involved and tell your story, Parent Advocacy Training, Deaf and Hard of Hearing Advocacy and more.

If you would like to join a CTFSN email distribution list in your region, please provide your email and town. You will receive emails with information on subjects that may include: Special Education, Support Groups, Public Policy and Legislation, How to get involved and tell your story, Parent Advocacy Training, Deaf and Hard of Hearing Advocacy and more. Email
Town

7. If you would like a CTFSN Regional Coordinator to contact you, please provide the following:

If you would like a CTFSN Regional Coordinator to contact you, please provide the following: Name:
Address:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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