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* 1. Name of Person Completing Survey

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* 2. Name of Facility

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* 3. Address of Facility

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* 4. Phone Number of Facility

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* 5. Email of Facility

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* 6. Type of Facility

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* 7. County

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* 8. What Traveling Trunk did you use

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* 9. Number of times the Trunk was used

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* 10. Number of children you used the Trunk with

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* 11. Please list the number of chidren in each age group you used the Trunk with.

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* 12. Did you use the activity guide?

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* 13. Please describe briefly how you used the Trunk

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* 14. Please rate the Trunk for its usefulness to you

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* 15. Would you recommend the Traveling Trunk to a co-worker or peer?

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