* 1. The Ombuds responded to me in a timely manner.

* 2. The Ombuds honored confidentiality.

* 3. The Ombuds listened to my concerns in a respectful manner.

* 4. The Ombuds helped me identify and evaluate options to address my concerns.

* 5. My concern has been resolved or diminished by using the Ombuds Office.

* 6. I would use the Ombuds Office again should the need arise. If not, please explain.

* 7. I would refer others to the Ombuds Office.

* 8. Please indicate what you would have done about your concern as an alternative to the Ombuds Office. Select all that apply.

* 9. I am:

* 10. I would like to provide anonymous testimonial for the use of the Ombuds Office.

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