Date of visit to Community Action Center?

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* 1. Date of visit to Community Action Center?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any other feedback or comments you would like to share about your 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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