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* 1. First Name

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* 2. Last Name (Optional)

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* 3. Email Address

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* 4. Name of School Child Attends

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* 5. What grade is your child currently in?

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* 6. What is your relationship to your child (Please circle response)?

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* 7. Number of children

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* 8. Age of children (please select all that apply)

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* 9. Ethnicity

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* 10. Where did you receive this Toolkit?

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* 11. What county do you live in?

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* 12. The zip code I live in is:

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* 13. I found this Toolkit to be helpful as a parent/caregiver.

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* 14. This Toolkit helped me be more comfortable in speaking to my kids about behavioral/mental health.

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* 15. This Toolkit helped increase my knowledge about behavioral/mental health.

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* 16. This Toolkit helped explain when I may need to be concerned about my child.

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* 17. This Toolkit provides resources available to support my child's behavioral/mental health.

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* 18. How likely are you to recommend this Toolkit to others?

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* 19. Please provide any additional comments or feedback regarding the presentation.

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