Date

Agency / Neighborhood Organization Name

Contact Person

Title (optional)

Address

City

State

ZIP

Daytime Phone

Fax (optional)

Email

How did you learn about Information Services at the Neighborhoods Resource Center?

What information did you receive from the Neighborhoods Resource Center?

For the next 3 questions, please indicate the most appropriate response.

(1) NRC Staff helped me understand the information I was provided.

Agree
Disagree
No Opinion

(2) The information I received helped me or my group understand something new about my neighborhood.

Agree
Disagree
No Opinion

NEIGHBORHOOD GROUPS ONLY:
(3a) The information I received helped me or my group identify or resolve a neighborhood problem.

Agree
Disagree
No Opinion

AGENCIES SERVING NEIGHBORHOODS ONLY:
(3b) The information I received helped me or my agency plan / evaluate our services related to children, youth, or health

Agree
Disagree
No Opinion

Please describe how the information was helpful:

What did you like about the information you received from NRC?

What could be improved about Information Services at NRC?

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