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Please take a moment to help us improve the services that are provided to you.  This assessment will be used to help with prevention strategies in our community. 

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* 1. What is your current DOD affiliation? Check ALL that apply:

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* 2. Are there children in the household? If yes, which age group? Check ALL that apply:

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* 3. Have you or any family member been deployed in the last 12 months?

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* 4. If you or any family member is/was deployed, please rate the level of contact with the Family Program Manager (FPM) check one:

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* 5. Do you or your family members currently need assistance with deployment related issues or anticipate that you will need assistance with any of the following in the next year?  Check ALL that apply:

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* 6. What information or referrals to the following services do you think you or your family members could benefit? Check ALL that apply:

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* 7. Indicate which life skill topics that you are interested in learning about.  Please check ALL that apply:

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* 8. Is there anything that prevents you from using Family Programs Services?
If so, please specify:

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* 9. How do you prefer to receive information on Family Programs Services?  Please check ALL that apply:

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* 10. Any suggestions on how we can improve our service to the community? Or any additional comments:

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