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1) Please tell us who you are:    Administrator Direct Support Staff Disability Advocate Educational Agency Family Member Human Service or Government Agency Staff Instructor OT Person with DisabilitY PT QMRP RN Researcher Staff from Disability/Advocate Organization Other

1a) Other (please specify):

During the past year, please tell us about the TA services that you received from the RRTCADD.

2) Please tell us what type of technical assistance you have received from the RRTCADD?
    (please check all that apply)

      Consultation
      Information    
      New Program Development    
      Program Implementation    
      Program/Project Evaluation    
      Project Proposal Development    
      Referral    
      Training Development/Delivery    

2a) Other (please specify):                                       

3) What was the general topic of your request?
    (please check all that apply)

      Clinical Information
      Development Ideas    
      Education/Training    
      Program Information    
      Publications    
      Research Information    

3a) Other (please specify):                                       

4) As a result of this technical assistance, which of the following occurred in your agency or organization?
    (please check all that apply)

      Further training was conducted related to aging and developmental disabilities.       # of participants trained  
      New materials were developed concerning aging and developmental disabilities.    

Please tell us about what materials were developed:                                       

      Programmatic changes were made in our agency/organization.    

Please describe the changes:                                       

      Changes were made in policies concerning aging and developmental disabilities.    

Please tell us about the changes:                                       

5) Overall, what is your level of satisfaction with the technical assistance that was provided?

Highly satisfied      Satisfied      Somewhat satisfied      Not at all satisfied     

5a) Please tell us what you liked or did not like about the technical assistance:    

5b) Please tell us how we could have been more helpful: