Outcome Assessment Form

Today's Date *

Month

Day

Year

Legal Business Name or DBA

First Name *

Middle Name or Initial (If applicable)

Last Name *

Phone number XXX-XXX-XXXX *

E-Mail Address *

Name of Provider *

A. Ontiveros & Associates LLC

Irish Enterprises Inc

Lois D Cohen

Metropolitan Contractors Improvement Partnership

Professional Business Development Group

What was your request? *

The technical assistance objectives requested were met. *

The provider was well prepared to meet your needs. *

The materials used were helpful. *

What are two new concepts/practices/ideas you learned that you can apply to your work? *

What resources or support do you need to be able to carry forward with this work? *

Do you have any other questions, comments, or suggestions for further collaboration? *

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