Thank you for RSVPing to attend Superior Counseling Services' Townhall Meeting. Please take 2 minutes to complete the following survey so that we can ensure that you have a Superior Experience! Looking forward to seeing you.

1.Please provide the following

Name

Address

Address 2

City/Town

State/Province

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code

Email Address

Phone Number

2.Check all staff that you work with.

Antoinette Kelly-Clark

Arlaina Moore

Audria Musgrove

Courtney Bledsoe

Clara Lewis

Carlos Morris

Dakota Weathers

Elizabeth Ware

Felecia Fox

Faith Jones

Fredrick Pinkney

Gretchen Dison

Heather Huber

Jasmine Billingsley

Jennifer Brown

Jordan Graham

Julia Moore

Joshua Murdock

Jack Murrell Jr.

Joyce White

Kimberly Rayson

Loni Moore

Mariah Odom

Mishuna MacDonald

Mary Speed

Netosha MacDonald

Pheadre Smith

Roderick Meaux

Robert Oliver III

Shanika Clark

Stephanie Lafayette

Stephanie McConnell

Sharon Perkins

Sharonda Thomas

Samaria Tisby

Shondolyn Truman

Twan Knight

Undria Sneed

Wynner Ward

3.Which Superior Location do you receive services from?

Ruston

Shreveport

4.How many guest are you bringing?

12345

5.If you are bringing a guest, please list their name/s.

6.Please list your food Allergies.

7.If you are affiliated with a company, please enter the company's name.