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EXHIBIT C <br />SAMPLE CLIENT SATISFACTION SURVEY <br />1. Did you find this call to the Warmline helpful? <br />2. Do you believe the Warmline counselor understood your concerns, problems, or challenges? <br />3. Would you call the Warmline again if you needed assistance? <br />4. Would you refer a family member or friend to this Warmline? <br />SAMPLE DEMOGRAPHIC INFORMATION QUESTIONS <br />1. What is your city of residence? <br />2. What is your zip code? <br />3. What is your age? <br />4. What is your gender? <br />5. What is your ethnicity? <br />a. Hispanic <br />b. Not Hispanic <br />6. What is your Race? <br />a. White <br />b. Black/African American <br />c. Asian <br />d. American Indian or Alaskan Native <br />e. Native Hawaiian or Pacific Islander <br />f. Amer. Ind. or Alask. Native and White <br />g. Asian and White <br />h. Black/African American and White <br />/_1"�Ta'MITI/_1F�:�►Fi�Tir�:317/_�i�_1' iL�� <br />j. <br />Other Multi -Racial Combinations <br />7. What is <br />your annual household income? <br />a. <br />Extremely low-income (0-30% AMI) <br />b. <br />Very Low Income (31-50% AMI) <br />c. <br />Low Income (51-80% AMI) <br />d. <br />Moderate Income (>80% AMI) <br />8. What <br />is your household type? <br />a. <br />Homeless <br />b. <br />Female -Headed Households <br />c. <br />Disabled/Special Needs <br />d. <br />San Leandro residents <br />