COPE - Center of Protective Environment

DVOTI Program Survey (Revised 6-09-2014)

THANK YOU for your help by answering this survey now.

This survey is voluntary and anonymous.
Your answers are very important to us and will help improve our programs and services.
This survey will take about 1 minute.

Question Title

* 1. Which COPE office did you receive services from?

Alamogordo

Ruidoso

Question Title

* 2. Please check the services or programs you have received from this agency within the past 12 months.

Intake / Assessment / Orientation Sessions

Individual / Group Sessions

Counseling

Question Title

* 3. Please estimate the number of weeks you have been receiving services.

1-8 weeks

9-16 weeks

17-32 weeks

33-48 weeks

49 weeks or more

Question Title

* 4. My behavior has affect my partner, my children and other family members and my community.

Agree

Not Sure

Disagree

Question Title

* 5. I take responsibility for my behavior and actions.

Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

Question Title

* 6. I have the skills, information, and knowledge to avoid being abusive in the future.

Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

COPE - Center of Protective Environment

DVOTI Program Survey (Revised 6-09-2014)

Question Title

* 1. Which COPE office did you receive services from?

Question Title

* 2. Please check the services or programs you have received from this agency within the past 12 months.

Question Title

* 3. Please estimate the number of weeks you have been receiving services.

Question Title

* 4. My behavior has affect my partner, my children and other family members and my community.

Question Title

* 5. I take responsibility for my behavior and actions.

Question Title

* 6. I have the skills, information, and knowledge to avoid being abusive in the future.

Question Title

* 7. Comments?