Thank you for your interest in collaborating with the Department of Corrections to provide services for our clients. Please fill out the survey below so we can learn more about your agency and the services you provide. If we have a need for the services your agency provides we will reach out to you. Thank you for your service to our community

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* 1. What is the name of your agency?

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* 2. In which area/counties are you able to provide services?

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* 3. What type of services does your agency provide? (Check all that apply)

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* 4. Provide a brief description of your services.

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* 5. What type of licensure/certification does your staff have?

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* 6. Is the staff in your agency trained in any specific curriculum? Please list the curriculums.

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* 7. In which area/counties are you able to provide services?

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* 8. How many clients can your program serve per year?

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* 9. Please tell us the cost of your agency's services per person per year.

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* 10. If you provide group services, please indicate the cost of each group session in the box below.

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* 11. Please provide contact name, email address and phone number.

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