ENTER FOR A CHANCE TO WIN A VISA GIFT CARD!
At the end of each month we will do a raffle of all form submissions, fill the form out below for a chance to win. Please be sure to enter your email address, so we can contact you. 
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OOOFC NEEDS ASSESSMENT
Please complete the below form so that we may better serve you and your community. All submissions are confidential.
Which type of peer support group interests you the most?
Which do you struggle with the most?
Do you have Health Insurance?
Do you see a Therapist or Counselor on a regular basis?
What group do you enjoy attending at On Our Own?
Do you recieve any of the following assistance? (Select all that apply)
Are you employed?
What is your current housing situation?
I feel safe with staff, volunteers and fellow peers at the center:
I feel my recovery is supported and important to staff, volunteers and fellow peers at the center:
I feel the rules and expectations are reasonable:
I feel the support groups that are offered are interesting and informative and help me in my recovery:
I feel my voice is heard and valued:
I feel my needs are addressed when I ask for assistance and support:
I would recommend On Our Own of Frederick to friends and community members:

STAFF FEEDBACK 
(2-3 MINUTES)

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USE THE SPACE BELOW TO PROVIDE FEEDBACK ON YOUR OVERALL INTERACTIONS WITH THAT PERSON. YOUR ANSWERS WILL REMAIN CONFIDENTIAL, WE JUST WANT TO ENSURE THAT YOU ARE GETTING THE SUPPORT YOU NEED.

 

HAVE YOU BEEN TO THE CENTER AND INTERACTED WITH OOOFC STAFF? IF NOT SCROLL TO THE BOTTOM AND CLICK SUBMIT.

Jill Krisnitsky, Executive Director

Have you interacted with Jill Krisnitsky, Executive Director? (if no, skip to the next question)
Please rate your experiences with Jill Krisnitsky, Executive Director - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):Please rate your experiences with Jill Krisnitsky, Executive Director - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):

Kristen Jean, Program Manager

Have you ever interacted with Kristen Jean, Program Manager? (If not, click NO and move on to the next question)
Please rate your experiences with Kristen, Program Manager - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):Please rate your experiences with Kristen, Program Manager - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):

Annette Boxley, Administrative Assistant

Have you interacted with ANNETTE BOXLEY, ADMINISTRATIVE ASSISTANT? (if no, skip to the next question)
Please rate your experiences with ANNETTE - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):Please rate your experiences with ANNETTE - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):

Cody Bruchey, Outreach & Peer Support Specialist

Have you interacted with CODY BRUCHEY, OUTREACH/PEER SUPPORT SPECIALIST? (if no, skip to the next question)
Please rate your experiences with CODY - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):Please rate your experiences with CODY - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):

Joao Martins, Facility Manager & Peer Support Specialist

Have you interacted with JOAO MARTINS, FACILITY MANAGER/PEER SUPPORT SPECIALIST? (if no, skip to the next question)
Please rate your experiences with JOAO - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):Please rate your experiences with JOAO - 1 star being the lowest (or poor) and 5 stars being the highest (or excellent):
Thanks for submitting!
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