1.What services did you receive from CIS today?

Food

Clothing

Crisis Counseling

Information/Referral 

Other (please specify)

2.After receiving services from CIS, do you feel you have more knowledge about community resources that are available to you?

Yes

No

3.After receiving services from CIS, do you feel you know more ways to plan for your safety?

Yes

No

4.What county do you reside in?

Appanoose

Davis

Jasper

Jefferson

Keokuk

Lucas

Mahaska

Marion

Monroe

Poweshiek

Wapello

Wayne

Other (please specify)

5.Did your self-esteem increase after receiving services from CIS?

Yes

No

Same as before