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* 2. I am:

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* 3. Today's Date (Date of  program or activity)

Date

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* 5. Participant's home zip code

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* 7. The program was educational

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* 8. I (or my child) will be able to use the knowledge gained from the program.

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* 9. The program will help me (or my child) develop or continue a love of reading.

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* 10. The program made me (or my child) more aware of available Library resources (i.e. books, electronic resources, programs, etc.).

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* 11. The program will help improve my (or my child's) confidence on the program's subject.

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* 12. The program met my expectations.

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* 13. The Library staff was courteous.

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* 14. What did you LIKE best about the program?

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* 15. What would you CHANGE the most about the program?

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* 16. Participant's race or ethnicity (please specify race or ethnicity)

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* 17. Participant's age

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* 18. Participant's sex

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* 19. Please provide any positive impacts of the program and/or any other general comments:

T