South Central Connecticut Regional Action Council



March 10, 2010

Newsletter

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Community Calendar

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Connecticut
Prevention Network

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Department of
Mental Health and
Addiction Services

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Prevention That Works

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Survey

Thank you for taking the time to take our survey. Before doing so please note the following: Any personal information (i.e. name, address, telephone number) will be kept confidential and will only be used for the purpose of notifying you if you are a winner. Answers you provide to the survey questions will not be linked to your personal information. The survey is completely anonymous. In order to qualify for prizes related to the survey you must complete the entire survey. Once you exit from the survey you will not be able to access the questions. Those who complete the survey will be eligible to win a gift certificate in the amount of $150, $100 and $50.

Please Note: Fields marked (*) are required.
Survey Entry Information

Email
First Name
Middle Name
Last Name
Address*
Address 2
Town*
State*
Zip Code*
Age*
Grade*
School*
Gender*
Race
Community Description
GPA

To complete this survey without entering any personal information click

If you choose not to fill out the required fields, SCCRAC will not be able to contact should you win any prizes. Any survey entries without the required fields will not be considered for prizes.

230 Ashmun Street, New Haven 06511 (203) 776-1981