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<form name="RRTCADD Technical Assistance Evaluation Survey" >

<mail name="mail1">
  <to>hsieh@uic.edu
  <cc>
  <cc>
  <cc>$email_2
<from>hsieh@uic.edu
  <Subject>RRTCADD Technical Assistance Evaluation Survey
  <body>

RRTCADD Technical Assistance Evaluation Survey
Date: $fm_date
Email: $email
Name: $name

1) Current job title
$s_job_title$job_title$e_job_title

If other, what is it?
$s_two_other$two_other$e_two_other


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?
$s_consultation_1$consultation_1$e_consultation_1
$s_information_2$information_2$e_information_2
$s_new_program_development_3$new_program_development_3$e_new_program_development_3
$s_program_implementation_4$program_implementation_4$e_program_implementation_4
$s_program_project_evaluation_5$program_project_evaluation_5$e_program_project_evaluation_5
$s_project_proposal_development_6$project_proposal_development_6$e_project_proposal_development_6
$s_referral_7$referral_7$e_referral_7
$s_training_development_delivery_8$training_development_delivery_8$e_training_development_delivery_8
2a) Other (please specify): $other_2

3) Please tell us what type of technical assistance you have received from the RRTCADD?
$s_clinical_information_1$clinical_information_1$e_clinical_information_1
$s_development_ideas_2$development_ideas_2$e_development_ideas_2
$s_education_training_3$education_training_3$e_education_training_3
$s_program_information_4$program_information_4$e_program_information_4
$s_publications_5$publications_5$e_publications_5
$s_research_information_6$research_information_6$e_research_information_6
3a) Other (please specify): $other_3

4) As a result of this technical assistance, which of the following occurred in your agency or organization?
$s_further_training_1$further_training_1$e_further_training_1
# of participants trained : $number_4a
$s_developed_new_materials_2$developed_new_materials_2$e_developed_new_materials_2
Please tell us about what materials were developed : $other_4a
$s_made_programmatic_changes_3$made_programmatic_changes_3$e_made_programmatic_changes_3
Please describe the changes : $other_4b
$s_made_policy_changes_4$made_policy_changes_4$e_made_policy_changes_4
Please tell us about the changes : $other_4c

5) Overall, what is your level of satisfaction with the technical assistance that was provided? : $5
Please tell us what you liked or did not like about the technical assistance : $satisfaction_5a
Please tell us how we could have been more helpful : $satisfaction_5b



	
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</mail>



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<![CDATA[
	<html><head><title>Thank You</title></head>
	<body>
	<p align = "center">
	<font face="Arial, Helvetica, sans-serif" size="3">
	<b>
		RRTCADD Technical Assistance Evaluation Survey<br>
		
	</b>

	<p>Thank you for sending us your feedback regarding our Technical Assistance.</b><br>
		If you have any additional questions or comments and you have given us your email, we will email you an answer as soon as possible.<br>
		
	</p>
	<hr>
	</font>
	</p>
	

	<p>
		Date: $fm_date<br>
		Email Addresses: $email<br>
		Name: $name<br><br>


<br>

1) Current job title
$s_job_title$job_title$e_job_title
<br><br>
If other, what is it?
$s_two_other$two_other$e_two_other
<br><br>

During the past year, please tell us about the TA services that you received from the RRTCADD. 
<br>
<br>
2) Please tell us what type of technical assistance you have received from the RRTCADD?
<br>
$s_consultation_1$consultation_1$e_consultation_1
<br>
$s_information_2$information_2$e_information_2
<br>
$s_new_program_development_3$new_program_development_3$e_new_program_development_3
<br>
$s_program_implementation_4$program_implementation_4$e_program_implementation_4
<br>
$s_program_project_evaluation_5$program_project_evaluation_5$e_program_project_evaluation_5
<br>
$s_project_proposal_development_6$project_proposal_development_6$e_project_proposal_development_6
<br>
$s_referral_7$referral_7$e_referral_7
<br>
$s_training_development_delivery_8$training_development_delivery_8$e_training_development_delivery_8
<br><br>

2a) Other (please specify):
$other_2
<br><br>

3) Please tell us what type of technical assistance you have received from the RRTCADD?
<br>
$s_clinical_information_1$clinical_information_1$e_clinical_information_1
<br>
$s_development_ideas_2$development_ideas_2$e_development_ideas_2
<br>
$s_education_training_3$education_training_3$e_education_training_3
<br>
$s_program_information_4$program_information_4$e_program_information_4
<br>
$s_publications_5$publications_5$e_publications_5
<br>
$s_research_information_6$research_information_6$e_research_information_6
<br>
<br>
3a) Other (please specify):
<br>
$other_3
<br><br>

4) As a result of this technical assistance, which of the following occurred in your agency or organization?
<br>
$s_further_training_1$further_training_1$e_further_training_1
<br>
# of participants trained : $number_4a
<br>
$s_developed_new_materials_2$developed_new_materials_2$e_developed_new_materials_2
<br>
Please tell us about what materials were developed : $other_4a
<br>
$s_made_programmatic_changes_3$made_programmatic_changes_3$e_made_programmatic_changes_3
<br>
Please describe the changes : $other_4b
<br>
$s_made_policy_changes_4$made_policy_changes_4$e_made_policy_changes_4
<br>
Please tell us about the changes : $other_4c
<br><br>

5) Overall, what is your level of satisfaction with the technical assistance that was provided? : $5
<br>
Please tell us what you liked or did not like about the technical assistance : $satisfaction_5a
<br>
Please tell us how we could have been more helpful : $satisfaction_5b



	</p>



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