Date of Meeting

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* 1. Date of Meeting

Date / Time
Location of Meeting

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* 2. Location of Meeting

Survey Question 1. What is the city closest to you and/or your organization?

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* 3. Survey Question 1. What is the city closest to you and/or your organization?

Survey Question. 2. Your ZIP Code:

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* 4. Survey Question. 2. Your ZIP Code:

Survey Question 3. What best describes your field of work?

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* 5. Survey Question 3. What best describes your field of work?

Survey Question 4. Have you ever heard of any of these organizations before today? – please check all that apply:

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* 6. Survey Question 4. Have you ever heard of any of these organizations before today? – please check all that apply:

Survey Question 5. Who are your most significant constituents, related to the work of legal aid organizations in Nevada?

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* 7. Survey Question 5. Who are your most significant constituents, related to the work of legal aid organizations in Nevada?

Survey Question 5a. Add description for the answers that were checked for question 5.

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* 8. Survey Question 5a. Add description for the answers that were checked for question 5.

Survey Question 6. How often do you or your organization refer people to any of the above legal aid organizations?

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* 9. Survey Question 6. How often do you or your organization refer people to any of the above legal aid organizations?

Survey Question 7.  What are the ONE or TWO most important UNMET civil legal needs or problems you see among the members of your constituency?

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* 10. Survey Question 7.  What are the ONE or TWO most important UNMET civil legal needs or problems you see among the members of your constituency?

Survey Question 9. Do you see specific ways in which your organization could work with a legal aid provider to improve services to your low income community?

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* 12. Survey Question 9. Do you see specific ways in which your organization could work with a legal aid provider to improve services to your low income community?

Survey Question 9.a. If "yes" to survey question 9, then please check all that apply:

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* 13. Survey Question 9.a. If "yes" to survey question 9, then please check all that apply:

Survey Question 10. Would you be willing to participate in a 15-minute phone conversation to discuss these topics further?

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* 14. Survey Question 10. Would you be willing to participate in a 15-minute phone conversation to discuss these topics further?

Survey Question 10.a. If you answered "yes" to survey question 10, then please provider your contact information below:

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* 15. Survey Question 10.a. If you answered "yes" to survey question 10, then please provider your contact information below:

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