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1. Date of visit to Community Action Center?

Date

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2. I received services or information that helped my situation about Basic Food.

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3. The staff person helped me understand the program/services and guidelines of Basic Food.

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4. If CAC could not provide me with help for Basic Food, the staff person helped with a referral for services elsewhere.

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5. On a scale of 1 to 7, how would you rate my overall experience with Community Action Center?

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6. Do you have any other feedback or comments you would like to share about your experience with Community Action Center?

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