MICA
Customer Satisfaction Survey

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* Please enter your five-digit postal code (ZIP Code).

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* What is your relationship to MICA?

I'm receiving a MICA service or someone I live with is receiving a MICA service.

My organization works with MICA.

I'm a MICA volunteer.

I'm a MICA employee.

I'm a member of a community MICA serves.

Other (please specify)

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* What is the topic of your feedback?

A good experience I had with MICA.

A bad experience I had with MICA.

I have a question I would like answered.

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* Please select the MICA program or service your feedback is about.

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* Please enter your feedback below, and please be as specific as possible. MICA's leadership team reviews this feedback regularly, and it's used to improve agency services and operations.

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* Would you like someone from MICA to contact you about your feedback?

Yes

No