* 1. Date of Meeting

Date / Time

* 2. Location of Meeting

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

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

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

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

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

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

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

* 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?

* 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?

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

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

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