Please take a few minutes to fill out this survey.

Please tell us how we are doing. We use your comments to make our services better and we also like to hear when we are doing things right! Your answers will be kept private – you only have to give your name if you want to. Your feedback is important to us, so thank you for taking the time to answer these questions.

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1. Please Enter:

Date
1. Demographics (Information about you).

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2. a. Your age:

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3. b. Your Race/Ethnicity (Check one only):

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4. c. Gender:

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5. d. Length in time in program

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