Survey

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Community assistance and services survey

1. During the past year, how many times did you want or need to protect yourself, a family member, or someone else from harm by another? *

1 2 3 4 0

If Other please specify: *

2. During the past year, what services have you looked for? *

Food or Shelter Protection from an abuser Medical Care Legal Services None Above

If Not Listed, Please Specify: *

3. Did you get the help you were looking for? *

Yes No N/A

5. If not, why were you not able to get help? *

Transportation Language Barrier Office Hours Afraid to leave house N/A

Comment *

4. What is your age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

5. What is your household income? *

Less than $10,000 $10,001 - $25,000 $25,001 - $40,000 $40,001 - $70,000 $70,001 - $100,000 Greater than $100,000 Prefer not to say

Submit

Suite 409, Marianas Business Plaza,
PO Box 502452
Saipan, MP 96950, USA

Office: (670) 234-9480
Fax: (670) 234-9487

https://www.facebook.com/pacificombudsman
@pacificombudsman

manager.pohlaw@gmail.com

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