Dayton Mediation Center - CIP Participant Evaluation Question Title * 1. The staff and/or mediator explained the Community Impact Panel well. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 2. The staff and/or mediator showed interest in helping me express my thoughts and feelings. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 3. The staff and/or mediator made efforts to help me understand the community representatives. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 4. This program was successful in helping me express my thoughts and feelings. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 5. This program was successful in helping me to better understand the community. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 6. This program was successful in helping the community representatives understand me. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 7. Because of this program, I am better able to make decisions about my situation. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 8. Because of this program, I am better able to address new problems as they arise. Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree Question Title * 9. Would you like for the case manager to follow-up with you? Yes No If yes, please enter your name and phone number Question Title * 10. Please share any additional comments or information you think might be helpful for us to know. Done