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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 Name: 

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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. How helpful was it to:

  1 - Not Helpful 2 - Somewhat Helpful 3 - Helpful 4 - Very Helpful
Meet and talk with other people who are facing similar problems?
Examine your beliefs about accepting responsibility for your behavior?
Learn about the dynamics and the types of domestic abuse?
Learn anger management skills?
Learn alternatives to abusive behaviors?
Learn about the impact of violence on children?
Learn about substance abuse and its relationship to violence?
Learn what signs to look for in an abusive personality?
Learn relaxation and stress management skills?
Learn conflict resolution techniques?
Learn how to set personal boundaries and respect others’ boundaries?

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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 explaining and discussing weekly topics and
course materials (handouts)?
How effective was this counselor in responding to group members’ questions and
concerns?

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

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* 6. How did your work in the New Horizons Program change your thinking and behavior?

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