Needs Assessment Survey

The CCB welcomes your participation in our "Needs Assessment" survey. We appreciate your time and comments. Thank you!

Question Title

1. Please provide the following: (Required.)

Full Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

2. How can the CCB best serve you? (Required.)

	Strongly Agree	Agree	Agree somewhat	Disagree	Strongly Disagree
Trainings	Trainings Strongly Agree	Trainings Agree	Trainings Agree somewhat	Trainings Disagree	Trainings Strongly Disagree
Interest in the certification process	Interest in the certification process Strongly Agree	Interest in the certification process Agree	Interest in the certification process Agree somewhat	Interest in the certification process Disagree	Interest in the certification process Strongly Disagree
Exam preparation	Exam preparation Strongly Agree	Exam preparation Agree	Exam preparation Agree somewhat	Exam preparation Disagree	Exam preparation Strongly Disagree

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3. What type of trainings would be beneficial for your agency? (Required.)

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4. What staffing credentials are you hiring for? (Required.)

Advanced Alcohol and Drug Counselor

Certified Addiction Counselor

Certified Clinical Supervisor

Certified Co-Occurring Disorders Professional

Certified Prevention Specialist

Certified Peer Recovery Support Professional

Counselor in Training

Specialty Certificate of Competency in Problem Gambling

Licensed Only

Licensed - Considering Certifications

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5. Would it be beneficial for a CCB representative to come to your agency a few times a year to review our Programs and Services? (Required.)

Yes

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* 1. Please provide the following: (Required.)

Question Title

* 2. How can the CCB best serve you? (Required.)

Question Title

* 3. What type of trainings would be beneficial for your agency? (Required.)

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* 4. What staffing credentials are you hiring for? (Required.)

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* 5. Would it be beneficial for a CCB representative to come to your agency a few times a year to review our Programs and Services? (Required.)

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* 6. What questions do you still have?

1. Please provide the following: (Required.)

2. How can the CCB best serve you? (Required.)

3. What type of trainings would be beneficial for your agency? (Required.)

4. What staffing credentials are you hiring for? (Required.)

5. Would it be beneficial for a CCB representative to come to your agency a few times a year to review our Programs and Services? (Required.)

6. What questions do you still have?