Exit this survey

1.

* 1. Name of Person Completing Survey

* 2. Name of Facility

* 3. Address of Facility

* 4. Phone Number of Facility

* 5. Email of Facility

* 6. Type of Facility

* 7. County

* 8. What Traveling Trunk did you use

* 9. Number of times the Trunk was used

* 10. Number of children you used the Trunk with

* 11. Please list the number of chidren in each age group you used the Trunk with.

* 12. Did you use the activity guide?

* 13. Please describe briefly how you used the Trunk

* 14. Please rate the Trunk for its usefulness to you

* 15. Would you recommend the Traveling Trunk to a co-worker or peer?

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