Provider Survey

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* 1. Which county are you in?

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* 2. To the best of my knowledge, what services does your CCR&R provide?

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* 3. What services have you used in the last year?

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* 4. How do you connect with us?

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* 5. Choose the three most valuable services:

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* 6. Please rate the following. (Leave question blank if unsure.)

  1. Strongly disagree 2. Disagree 3. Agree 4. Strongly Agree
Staff are knowledgeable
Staff answered my question(s)
Staff are professional
Staff are involved in community collaborations

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* 7. Do you/would you refer CCR&R services?

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* 8. What improvements could CCR&R's make or recommendations do you have?

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* 9. What is your greatest concern about early care & education in your community?

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* 10. Optional: Name of agency & name of person filling out survey.

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* 11. Would you like to be contacted about this survey?

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* 12. If yes, please list your contact information.

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