SJ County Survey

The Lisa Project Feedback

Questions marked with * are required

Question Title

* 1. Please rate your level of awareness about child abuse after viewing the exhibit. *

None at all

A little

A moderate amount

A lot

A great deal

Other (please specify)

Question Title

* 2. What part of this exhibit stood out to you the most and why? *

Question Title

* 3. Please indicate your age & gender by checking the appropriate boxes: *

Male

Female

Other

13-17

18-24

25-35

36-45

46-55

56-65

65+

Question Title

* 4. If you are interested in being part of our efforts to prevent child abuse, please complete the following:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 5. Areas of Interest (Check all that apply)

Volunteering

Newsletter - Please provide email address in previous question

Information on being a Foster/Adoptive Parent

Information on other child advocacy programs

Other

Other (please specify)

Question Title

* 6. Is there anything else you would like to share with us?
(PLEASE NOTE: If you disclose information and you are under the age of 18, we are legally mandated to report any and all abuse)

SJ County Survey

The Lisa Project Feedback

Question Title

* 1. Please rate your level of awareness about child abuse after viewing the exhibit. *

Question Title

* 2. What part of this exhibit stood out to you the most and why? *

Question Title

* 3. Please indicate your age & gender by checking the appropriate boxes: *

Question Title

* 4. If you are interested in being part of our efforts to prevent child abuse, please complete the following:

Question Title

* 5. Areas of Interest (Check all that apply)

Question Title

* 6. Is there anything else you would like to share with us?
(PLEASE NOTE: If you disclose information and you are under the age of 18, we are legally mandated to report any and all abuse)

Question Title

* 7. Do you need help finding local resources ( Counseling services, etc) ? *

Question Title

* 8. May we contact you about this? If so, what is the best way to reach you?

SJ County Survey

The Lisa Project Feedback

Question Title

* 1. Please rate your level of awareness about child abuse after viewing the exhibit. *

Question Title

* 2. What part of this exhibit stood out to you the most and why? *

Question Title

* 3. Please indicate your age & gender by checking the appropriate boxes: *

Question Title

* 4. If you are interested in being part of our efforts to prevent child abuse, please complete the following:

Question Title

* 5. Areas of Interest (Check all that apply)

Question Title

* 6. Is there anything else you would like to share with us?(PLEASE NOTE: If you disclose information and you are under the age of 18, we are legally mandated to report any and all abuse)

Question Title

* 7. Do you need help finding local resources ( Counseling services, etc) ? *

Question Title

* 8. May we contact you about this? If so, what is the best way to reach you?

* 6. Is there anything else you would like to share with us?
(PLEASE NOTE: If you disclose information and you are under the age of 18, we are legally mandated to report any and all abuse)