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* 1. What county do you live in?

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* 2. Did you apply for Energy Assistance last year?

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* 3. If you are a NEW applicant, how did you hear about the Energy Assistance program? (Check all that apply)

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* 4. The application packet included a checklist which listed all the required documentation to be submitted. Was this form easy to understand?

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* 5. Which of these do you do to conserve energy? (Check all that apply)

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* 6. Were you treated with respect by Pace staff?

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* 7. Did you require assistance completing your application

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* 8. Additional Comments or suggestions:

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