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* 1. What Tri-CAP programs or services have you used in the last 12 months? (mark all that apply)

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* 2. Overall, how satisfied or dissatisfied are you with the service(s)?

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* 3. How did you learn about Tri-CAP?

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* 4. How well do Tri-CAP's programs and services meet your needs?

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* 5. Please identify any benefits or impacts you have experienced as a result of working with Tri-CAP. (Mark all that apply)

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* 6. Thinking about the program or services you used, how would you rate the quality of service provided?

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* 7. How likely are you to use Tri-CAP programs or services again?

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* 8. Why are you likely or not likely to work with Tri-CAP again?

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* 9. How responsive has Tri-CAP been to your questions or concerns about the programs and service?

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* 10. Do you have any suggestions for improvement of Tri-CAP service?

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* 11. Any other comments?

These final 3 questions are asked to help us determine if we have received responses from a cross section of Tri-CAP clients. If you are not the program client, please answer using the information of the person who uses the program.

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* 12. What is your age?

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* 13. What is your gender?

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* 14. Which race/ethnicity best describes you? (Please choose only one.)

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