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Center Disability Partnership Survey (open)

Please answer the following questions to help us better understand the partnerships our centers have with outside agencies.

Question details
1 (Required)
2 (Required)
Enter your name in following format: Last Name, First Name
3 (Required)
Enter your position title.
4 (Required)
Enter your center area code, phone number, and extension (if applicable).
5 (Required)
Enter your center e-mail address.
6 (Required)
Yes
No (Survey complete, click submit button at bottom of page. Thank you!)
7
Check all that apply.
Department of Vocational Rehabilitation? (If checked, complete questions 8-13)
Center for Independent Living? (If checked, complete questions 14-19)
Other agencies (If checked, list below and complete questions beginning with question 20)
List other agencies:

8
Provide official agency name.
9
Yes
No
If no, describe how your center accesses agency services.

10
Provide brief description of the types of services provided to the center and its students.
11
Check all that apply.
While student is enrolled in Job Corps
After student leaves Job Corps
Other (explain below)
"Other" explanation

12
Check all that apply.
Agency staff come to center
Student goes to agency facility
Other (explain below)
"Other" explanation

13
14
Provide official agency name.
15
Yes
No
If no, describe how your center accesses agency services.

16
Provide brief description of the types of services provided to the center and its students.
17
Check all that apply.
While student is enrolled in Job Corps
After student leaves Job Corps
Other (explain below)
"Other" explanation

18
Check all that apply.
Agency staff come to center
Student goes to agency facility
Other (explain below)
"Other" explanation

19
20
Provide official agency name.
21
Yes
No
If no, describe how your center accesses agency services.

22
Provide brief description of the types of services provided to the center and its students.
23
Check all that apply.
While student is enrolled in Job Corps
After student leaves Job Corps
Other (explain below)
"Other" explanation

24
Check all that apply.
Agency staff come to center
Student goes to agency facility
Other (explain below)
"Other" explanation

25
26
Provide official agency name.
27
Yes
No
If no, describe how your center accesses agency services.

28
Provide brief description of the types of services provided to the center and its students.
29
Check all that apply.
While student is enrolled in Job Corps
After student leaves Job Corps
Other (explain below)
30
Check all that apply.
Agency staff come to center
Student goes to agency facility
Other (explain below)
"Other" explanation

31
32
Provide official agency name.
33
Yes
No
If no, describe how your center accesses agency services.

34
Provide brief description of the types of services provided to the center and its students.
35
Check all that apply.
While student is enrolled in Job Corps
After student leaves Job Corps
Other (explain below)
"Other" explanation

36
Check all that apply.
Agency staff come to center
Student goes to agency facility
Other (explain below)
"Other" explanation

37
 

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