Program Survey 2020

PLEASE take just a few minutes out of your group time to complete this survey. We need your help to know if our groups are working and how to make them better. Because we want your honest feedback, please do not put your name on the survey. Thank you.

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* 1. Date

Date:

Date

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* 2. Location of the Group:

Other (please specify)

TELL US ABOUT YOURSELF:

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* 3. What is your gender?

Female

Male

Transgender

Other

Prefer not to say

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* 4. What is your age range?

18-21

22-30

31-40

41-50

51-65

65+

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* 5. How far did you go in school?

Less Than High School

GED Completed

High School Completed

Some College

College Completed

Some Graduate School

Graduate School Completed

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* 6. When you were a child did you experience physical, verbal, or emotional abuse?

Yes

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* 7. Has your child experienced physical, verbal, or emotional abuse?

Yes

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* 8. What is your family's approximate income per year?

Under $10,000

$10,000 - $20,000

$20,000 - $30,000

$30,000 - $50,000

Over $50,000