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* 1. Evaluator Information:

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* 3. Date of Review:

Select today's date below.
II. EVALUATION 

Completely Disagree = 1           Do Not Agree = 2           Neutral = 3           Agree = 4            Completely Agree = 5

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* 6. Is there anything else you would like to share regarding the translation?

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* 7. Would you be willing to be contacted should the PRAPARE team have follow-up questions based on your responses?

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* 8. If you responded Yes to the question above, please provide your contact information below.

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