Standard form #27B/j

Please take a few minutes to fill out this
questionaire. All answers will be kept
confidental and are used only for research
purposes.

1: How did you hear about us?
   __________________________________________

2: Did you enjoy your overall experience?
   ___ Yes  ___ No

   If not, why not? _________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________

3: Is this your first protest with this
   (office)? ___ Yes  ___ No

4: On a scale of 1 to 10, please rate the
   following aspects of our service:

 (circle one)

Representative access 1 2 3 4 5 6 7 8 9 10
Employee politeness   1 2 3 4 5 6 7 8 9 10
Toilet availability   1 2 3 4 5 6 7 8 9 10
Snacks                1 2 3 4 5 6 7 8 9 10
Parking               1 2 3 4 5 6 7 8 9 10

5: Would you come back and protest again?
   ___ Yes  ___ No

6: How can we make future protests more
   fulfilling for you? ______________________
 ____________________________________________
 ____________________________________________
 ____________________________________________
 ____________________________________________

Thank you for your time.  Your answers will
help (this office) become more responsive to
protester needs as part of our service goals.