Spirit of Hope Partner Agency Family Training Survey


1. Agency:
2. Contact Person:
3. Title:
4. Phone:
5. E-mail:
6. Please provide a list of the services/programs you provide, and in the following question, please provide the number of service providers that you employ for each program at each educational level. (You must fill out at least one row)
7. For each of the services listed above, please indicate the number of service providers at each educational level. Please include licensure, if you have that information, in the comment box. (You must fill out at least one row)
Program/Service 1
Program/Service 2
Program/Service 3
Program/Service 4
Program/Service 5
8. Thinking about topics for training in family practice, please rate the following based on their importance on the following scale:

1 = most important
2 = somewhat important
3 = not important
1 (Most Important)2 (Somewhat Important)3 (Not Important)
Couples Communication
Family communication
Adolescent problems
Childhood problems
Cultural Competency
Families in Transition (e.g, new job, new child)
Unemployment/financial problems
Substance Abuse
Domestic Violence
Family Resilience
9. Are there any areas in which your agency would definitely NOT want training?
10. Other Comments:
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