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* 1. Please select your city:

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* 2. Name of Organization:

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* 3. During our event, we discussed the various needs of survivors of domestic abuse. Please select the needs that your organization can fulfill:

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* 4. How effective was the initial program in increasing your understanding of the needs of Jewish survivors of domestic abuse?

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* 5. Please rate your level of agreement with the following statements:

  Strongly Disagree Somewhat Disagree Neutral (Neither Agree nor Disagree) Agree Strongly Agree
I know steps I should take if someone discloses abuse to me.
I understand the barriers that survivors face in disclosing abuse and ways to help overcome those barriers.
I am aware of ways to make my organization a more welcoming space for survivors of domestic abuse.

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* 6. Which actions do you plan to take following this workshop? (Select all that apply)

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* 7. What areas of the workshop do you feel could be improved?

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* 8. Are you interested in any additional resources or workshops? Select all that apply.

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* 9. Are there any additional ways you would like to be involved in this initiative?

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* 10. Would you like a certificate of participation? (If yes, please provide your name):

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* 11. Additional Comments

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