| First Name
|
|
| Last Name
|
|
| Street Address
|
|
| City
|
|
| State
|
|
| Zip/Postal Code
|
|
| Country
|
|
| Phone
|
|
| E-mail Address
|
|
| Population of your community
|
|
<10,000
|
10,000-25,000
|
|
25,000-50,000
|
50,000+
|
| Geographic area served (in square miles)
|
<100 sq. miles
|
100-500 sq. miles
|
|
501-1,000 sq. miles
|
1,000+ sq. miles
|
| Gender
|
|
Male
|
Female
|
| Education (pick highest level)
|
|
High School
|
College (1 - 3)
|
|
BA/BS/MA/MS/MBA
|
Ph. D
|
| Occupation
|
|
| Discipline affiliation
|
|
Animal Welfare
|
Local Law Enforcement
|
|
Child Advocacy Centers
|
Child Protective Services
|
|
Concerned Citizen
|
Corrections
|
|
Court Appointed Special Advocates
|
Federal Law Enforcement
|
|
Legal Services
|
Medical Facilities
|
|
Mental Health / Substance Abuse Services
|
Probation
|
|
Prosecution
|
School Districts
|
|
Research
|
Victim Advocates
|
|
-- Other --
|
| My level of contact with DVERT has been
|
|
None
|
I have looked at the Web Site
|
|
I have the CD
|
I have been to a DVERT site visit
|
| How did you find out about DVERT or our Web site?
|
|
News Article
|
A friend or casual acquaintence
|
|
Through an Internet search
|
At a conference / meeting
|
|
In a journal article
|
A professional colleague
|
| What information did you hope to find on this Web site?
|
I was browsing to find out general information about domestic violence
I was looking for information about domestic violence services
I was looking for information about domestic violence services in El Paso County
I was looking for information about collaborations to address domestic violence
|
| Did you find the type and quality of information you were seeking?
|
|
Yes
|
No
|
| If "no," which area needed more clarity?
|
Phone numbers
Agency names/addresses/links
Information on collaboration
Information on DVERT
Information about domestic violence in general
|
| Please select the item that corresponds to your community’s experience with multidisciplinary collaboration to address domestic violence
|
Never attempted it
We've tried, but failed
We're working on it
We've had a collaboration working for over a year
|
| A successful collaborative effort in my community is a real possibility
|
Strongly Agree
Agree
Not Sure
Disagree
Strongly Disagree
|
| Regardless of my estimate, I still see a need for such a program in my community
|
Strongly Agree
Agree
Not Sure
Disagree
Strongly Disagree
|
|
|
|
