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Questions marked with an * are required Exit Survey
 
 
* First Name : 
* Last Name : 
* Name of School/Organization : 
   Address : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
 
 
 
* County/Borough
   
 
 
 
* How prepared was your school for the DTYCTS event?
 
1 (Not Prepared)
 
2
 
3
 
4
 
5 (Very Prepared)
 
 
 
* How useful was the DTYCTS website for planning the event?
 
1 (Not Useful)
 
2
 
3
 
4
 
5 (Very Useful)
 
 
 
* How helpful was your community partner in planning the event?
 
1 (Not Helpful)
 
2
 
3
 
4
 
5 (Very Helpful)
 
N/A
 
Name of Community Partner
 

 
 
 
How many fathers attended your DTYCTS event?
   
 
 
 
* Are you planning on having a follow up activity?
 
Yes
 
No
 
 
 
* What program components did your DTYCTS event incorporate (check all that apply)?
 
Speaker
 
Food
 
Prizes
 
Media
 
Activities
 
Resources and Flyers
 
Sign-Ups/Recruitment Opportunities
 
Other
 

 
 
 
* What theme did your school decide to use for DTYCTS?
 
Financial Literacy and Asset Building
 
Job Development and Educational Advancement
 
Improving Literacy and Homework Help
 
Health and Wellness for Men and Families
 
School Safety and Volunteer Opportunities
 
Supporting Immigrant Families
 
Other
 
 
 
 
Do you have any suggestions, recommendations or comments for DTYCTS? Is there anything you would like to share about the event or the planning of the event? Are you interested in having your school featured in the DTYCTS 2013 report? If so, indicate below and provide the contact information of who to contact for a testimonial.