Extension Faculty Assisting with Flood and Tornado Recovery:
Indicate answering is voluntary and confidential and is part of program evaluation
research to assist in better serving Missourians in the future. If persons prefer not to
respond, that is fine and their responses or decision not to answer will not affect our
providing any additional education or information.
Indicate if there are any questions/concerns about their rights in answering these
questions, contact Mary Leuci 573-882-2937, 232 Gentry Hall, Columbia, MO 65211,
leucim@missouri.edu; or the MU Institutional Review Board, 483 McReynolds Hall,
Columbia, MO 65211, 573-882-9585, umcresearchcirb@missouri.edu.
Thank them.
Please complete the four questions on the half-sheet with any comments from the
individual. This is an informal way of asking people what they will do with the information
we have provided and how we are doing in meeting their needs. When completed place this
page in a separate envelope.
Questions
1. Was the information/assistance provided what you needed?
Yes
No
Unsure
2. Would you recommend MU Extension to others needing such assistance?
Yes
No
3. How do intend to use what you have learned or gained?
4. Other comments (If comments seem good, ask permission to use with name and check yes.
If person seems reticent, do NOT even ask.)
Revised 06/30/11