EmailMe Form - Car Control Clinic Survey

1. What outside source did you or your parent(s) learn about the Teen School? *
2. Please select the event you were attending: *
3. Please select the category that best describes you: *
4. Was information about this Clinic easy to find? *
Yes
No
5. Was the information clearly presented? *
Yes
No
6. Do you feel that this program should be a requirement for all new drivers? *
Yes
No
7. What other information should we provide at these Clinics? *
8. How can we make this a better experience? *
9. Anything else that you would like to tell us?
10. Overall, how would you rate our Clinic? *

Great Good Average Fair Poor

Accessibility 1 2 3 4 5

Content 1 2 3 4 5

Presentation 1 2 3 4 5
11. Please enter your email address(optional)
12. Name
First Last
13. Did you have a photo or video you wanted to share?
File size is limited to 2Mb

	Great	Good	Average	Fair	Poor
Accessibility	1	2	3	4	5
Content	1	2	3	4	5
Presentation	1	2	3	4	5