2020-2021 Outcome Survey Ind/Families

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* 1. Name

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* 2. Date

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* 3. Email

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* 4. Phone

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* 5. What event, activity, or grant are you filling this out for?

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* 6. What town do you live in?

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* 7. Race/Ethnicity

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* 8. Age

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* 9. Gender

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* 10. Please choose the statement that best describes you

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* 11. Are you willing to be contacted to share your story with us? 
If yes, how can we contact you?

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* 12. How has/will this program help you? (Check all that apply.)

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* 13. Check all the ways this program has will help you to better advocate for yourself and others.

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* 14. What kind of advocacy activities has/will this program help you do better?

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* 15. Do you participate in any of the following? Check all that apply.

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* 16. Are you satisfied with the event/grant?

T