Which program or programs have you participated in?  Please    check all that apply.

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* 1. Which program or programs have you participated in?  Please    check all that apply.

How was the enrollment or application process?

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* 2. How was the enrollment or application process?

Agency staff treated me with respect and was sensitive to my
situation and needs.

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* 3. Agency staff treated me with respect and was sensitive to my
situation and needs.

Agency was able to meet my needs.

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* 4. Agency was able to meet my needs.

Agency staff were not able to meet my needs but I was referred to other resources.

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* 5. Agency staff were not able to meet my needs but I was referred to other resources.

How did you hear about us?

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* 6. How did you hear about us?

Do you have any additional comments?

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* 7. Do you have any additional comments?

Name (optional)

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* 8. Name (optional)

Would you like to be contacted?

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* 9. Would you like to be contacted?

Contact information (phone number, email, etc.)

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* 10. Contact information (phone number, email, etc.)

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