Please provide the following information:

Zip Code:
Family Status:	Please select from the list Married Single Divorced Single Parent Alternative Relationship Widowed Other
Gender:	Please select from the list Female Male
Race:	Please select from the list Caucasian African American Hispanic Bi/Multi-Racial Other
If Other was selected, specify:
Cultural Background:
Primary Language:
Age:	Please select from the list Under 18 18 to 25 26 to 35 36 to 45 46 to 55 56 to 65 Over 65
Pick the answer that most closely reflects how you feel:
1. The staff at KinKonnect was friendly. Strongly Agree Agree Neutral Disagree Strongly Disagree
2. The staff at KinKonnect was helpful. Strongly Agree Agree Neutral Disagree Strongly Disagree
3. The assistance I received was handled timely. Strongly Agree Agree Neutral Disagree Strongly Disagree
4. I received adequate assistance and information to meet my needs. Strongly Agree Agree Neutral Disagree Strongly Disagree
5. The staff at KinKonnect seemed to be knowledgeable regarding my questions and concerns. Strongly Agree Agree Neutral Disagree Strongly Disagree
6. I would contact the KinKonnect in the future if I had additonal questions or concerns. Strongly Agree Agree Neutral Disagree Strongly Disagree
7.  would refer a friend to KinKonnect if they had questions or concerns  about adoption. Strongly Agree Agree Neutral Disagree Strongly Disagree
8. I have increased my knowledge and understanding of some aspect of kinship legal guardianship through my contact with KinKonnect. Strongly Agree Agree Neutral Disagree Strongly Disagree
I contacted the KinKonnect Warm Line to find out about:
Any additional comments:
If you would like the KinKonnect to contact you regarding this  survey please provide us with either a phone number:
Or e-mail address:
Thank you so much for your participation, your contribution is appreciated!