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* 1. Please fill out your First and Last name. If there are any changes to your phone number and/or mailing address or if you would like to confirm we have the correct information on file, please confirm that here. This updated information will be beneficial for when we mail your completion certificate. 

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* 2. Facilitator:

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* 3. Please use the following scales to answer the questions below. Your answers will only be used to improve the program, not evaluate you. In relation to domestic abuse issues, how helpful was it to:

  1 - Not helpful 2 - Somewhat helpful 3 - Helfpul 4 - Very helpful
Learn ways to improve your self-esteem?
Learn non-abusive methods for resolving conflict?
Understand the barriers to communication?
Improve your listening skills?
Learn ways of improving your communication?
Learn parenting techniques?
Understand the relationship between alcohol and domestic abuse?

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* 4. Please rate the group facilitator:

  1 - Not effective 2 - Somewhat Effective 3 - Effective 4 - Very Effective
How effective was this counselor in giving clear and understandable instructions?
How effective was this counselor in confronting and challenging group members when appropriate?
Overall, how effective was this counselor?

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* 5. What suggestions do you have to improve the New Thresholds Program?

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* 6. How did your work in the New Thresholds program change your thinking and behavior?

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