# SSFieldData

Caption:
talking to someone who understands my situation


Caption:
help with safe visitation for my children


Caption:
help with child protection hearings or requirements


Caption:
help with my children’s school (e.g. records, changing schools, etc.)


Caption:
help with health insurance for my children


Caption:
help getting medical benefits (e.g. Medicaid)


Caption:
help getting access to mental health services


Caption:
help getting access to substance abuse services


Caption:
help with government benefits (e.g. welfare/ TANF, food stamps, others)


Caption:
learning more about why/how domestic violence happens


Caption:
help meeting my child’s disability-related needs


Caption:
help meeting my needs related to my disability


Caption:
information about the legal system process


Caption:
information about my legal rights and options


Caption:
help stopping the court case against the person who abused me


Caption:
help dealing with sexual abuse services for me or my children


Caption:
help understanding my rights && options related to my residency status


Caption:
help getting support from my faith community


Caption:
help arranging transportation to meet my needs


Caption:
About how many advocacy-related contacts with program staff have you had in the last year (your best guess)?


Caption:
Have you been a shelter resident during any part of this time?


Caption:
Have you completed this form before, during the past year?


Caption:
that I will achieve the goals I set for myself


Caption:
Program staff were caring and supportive.


Caption:
Program staff spent enough time talking about my safety


Caption:
Over all, my religious/spiritual beliefs were respected


Caption:
Over all, my sexual orientation was respected


Caption:
Over all, my racial/ethnic background was respected


Caption:
Program staff helped address any needs related to my disability


Caption:
Progam staff helped address any needs related to my youth or advancing age


Caption:
Is there anything the program could do to improve our advocacy services?


Caption:
Over all, thinking about my experience with this program so far, I would rate the help I received at this shelter as:


Caption:
If a friend of mine told me she was thinking of coming here for help, I would: (please check one)


Caption:
If there is a particular ethnic background that is important to you, please identify:


Caption:
The highest level of education I have so far is:


Caption:
help supporting the court case against the person who abused me


# AFieldData

Caption:
talking to someone who understands my situation


Caption:
help with safe visitation for my children


Caption:
help with child protection hearings or requirements


Caption:
help with my children’s school (e.g. records, changing schools, etc.)


Caption:
help with health insurance for my children


Caption:
help getting medical benefits (e.g. Medicaid)


Caption:
help getting access to mental health services


Caption:
help getting access to substance abuse services


Caption:
help with government benefits (e.g. welfare/ TANF, food stamps, others)


Caption:
learning more about why/how domestic violence happens


Caption:
help meeting my child’s disability-related needs


Caption:
help meeting my needs related to my disability


Caption:
information about the legal system process


Caption:
information about my legal rights and options


Caption:
help stopping the court case against the person who abused me


Caption:
help dealing with sexual abuse services for me or my children


Caption:
help understanding my rights && options related to my residency status


Caption:
help getting support from my faith community


Caption:
help arranging transportation to meet my needs


Caption:
About how many advocacy-related contacts with program staff have you had in the last year (your best guess)?


Caption:
Have you been a shelter resident during any part of this time?


Caption:
Have you completed this form before, during the past year?


Caption:
that I will achieve the goals I set for myself


Caption:
Program staff were caring and supportive.


Caption:
Program staff spent enough time talking about my safety


Caption:
Over all, my religious/spiritual beliefs were respected


Caption:
Over all, my sexual orientation was respected


Caption:
Over all, my racial/ethnic background was respected


Caption:
Program staff helped address any needs related to my disability


Caption:
Progam staff helped address any needs related to my youth or advancing age


Caption:
Is there anything the program could do to improve our advocacy services?


Caption:
Over all, thinking about my experience with this program so far, I would rate the help I received at this shelter as:


Caption:
If a friend of mine told me she was thinking of coming here for help, I would: (please check one)


Caption:
If there is a particular ethnic background that is important to you, please identify:


Caption:
The highest level of education I have so far is:


Caption:
help supporting the court case against the person who abused me


