* 1. Date of Visit

* 2. Did you receive the assistance you requested?

* 3. If you were not provided with assistance, were you referred to another agency for assistance?

* 4. The person who assisted me was knowledgeable about services?

* 5. I was assisted with more than what I came in for?

* 6. I was treated with respect during my visit?

* 7. Would you refer a friend or family member to CCAP?