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* 1. Date of visit to Community Action Center?

Date

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* 2. What kind of help did you NEED from CAC when you visited? (For example, Utility Assistance, Emergency Food, Section 8 help, Weatherization, etc.)

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* 3. I received services, information, or a referral that helped my situation.

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* 4. What kind of help did you receive from CAC, if any?

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* 5. The staff person helped me understand the program/services & guidelines.

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* 6. If CAC could not provide the help you needed, the staff person helped with a referral for services elsewhere.

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* 7. I was informed of other services offered at Community Action Center.

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* 8. If there are no services/referrals for the need you have, please list unmet need(s) below:

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* 9. On a scale of 1 to 10, how would you rate your overall experience with Community Action Center?

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* 10. Do you have any other feedback or comments you would like to share about your experience with Community Action Center?

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