NAMI Seattle Program Feedback Form Thank you so much for taking the time to share your honest and thoughtful feedback about NAMI Seattle's programs. If you wish to contact our Program Manager directly, you are welcome to do so at katie@namiseattle.org. OK Question Title * 1. Which NAMI Seattle program are you providing feedback about? In Our Own Voice Ending the Silence Family-to-Family/De Familia a Familia Peer-to-Peer Family & Friends/Familia y Amigos Smarts for Advocacy Support Group Other (please specify) OK Question Title * 2. If you participated in any of the above programs, were you (check all that apply): An attendee, participant, or audience member A trainee (training to become a presenter, facilitator, or teacher) A presenter, facilitator, or teacher Other (please specify) OK Question Title * 3. If you are describing a specific meeting, presentation, or class, when did it take place? Date / Time Date Time AM/PM - AM PM OK Question Title * 4. Where did this program take place? OK Question Title * 5. Please describe your experience in as much detail as you wish. This information will be sent directly to NAMI Seattle's Program Manager. You will have the option to let us know whether you prefer your feedback to remain confidential, or to be shared with the program leader. OK Question Title * 6. If you had a positive experience, what made it so good? OK Question Title * 7. If you did not have a good experience, what would have made it better? OK Question Title * 8. Optional contact information (this will allow our Program Manager to follow up with you to ask clarifying questions or provide any updates about your feedback) Name ZIP/Postal Code Email Address Phone Number OK Question Title * 9. What level of confidentiality do you prefer? I prefer my feedback to remain confidential ONLY to the Program Manager (Please note: If you expressed concerns that may impact program quality or the safety/experience of other participants, the Program Manager may need to communicate with program leaders. However, we will strive to do so in a way that protects your identity as much as possible.) I prefer to remain anonymous, but NAMI Seattle may share my feedback with program leader(s) NAMI Seattle may share my name and feedback with program leader(s) I prefer to remain anonymous, but NAMI Seattle may share my feedback with the wider community NAMI Seattle may share my first name and feedback with the wider community Other (please specify) OK DONE