All answers are confidential. Please do not put your name or identifying information on this survey unless you want to be contacted to discuss concerns.

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* 1. Date:

Date

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What is your race or ethnicity?

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* 5. Who recommended this group to you?

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* 6. How many times have you seen a PAL?

Please indicate your responses to the following questions.

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* 7. I feel better able to deal with this issue

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* 8. If I was overwhelmed when I came, I am feeling less overwhelmed now.

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* 9. I feel like I have more tools for dealing with this issue.

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* 10. It was an easy process to see a PAL.

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* 11. The PAL was sensitive to my feelings.

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* 12. I found speaking to this PAL helpful.

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* 13. I would recommend using a PAL to a friend.

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* 14. I would come to a PAL again if needed.

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* 15. Name of PAL you saw today:

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* 16. What school do you attend?

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* 17. Would you like to be contacted by a PAL Advisor for follow up?

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