GHA CONSULTANT:                     YOUR ROLE IN THE CONSULTATION:
             
              

EVALUATION DATE:                   DATE(S) OF VISIT:        ORGANIZATION:
                                     
                                   
CITY:                              STATE:
                 State/TerritoryAlabama AL Alaska AK American Samoa AS Arizona AZ Arkansas AR California CA Colorado CO Connecticut CT Delaware DE District of Columbia DC Florida FL Georgia GA Guam GU Hawaii HI Idaho ID Illinois IL Indiana IN Iowa IA Kansas KS Kentucky KY Louisiana LA Maine ME Maryland MD Massachusetts MA Michigan MI Minnesota MN Mississippi MS Missouri MO Montana MT Nebraska NE Nevada NV New Hampshire NH New Jersey NJ New Mexico NM New York NY North Carolina NC North Dakota ND Northern Mariana Islands MP Ohio OH Oklahoma OK Oregon OR Pennsylvania PA Puerto Rico PR Rhode Island RI South Carolina SC South Dakota SD Tennessee TN Texas TX Utah UT Vermont VT Virgin Island VI Virginia VA Washington WA West Virginia WV Wisconsin WI Wyoming WY                      



GHA PROJECT (IF KNOWN):



CONSULTATION PURPOSE:



1. WAS YOUR ANTICIPATED OUTCOME FOR THE CONSULTATION ACHIEVED?
   EXPLAIN BRIEFLY:



2. WAS THE CONSULTANT ADEQUATELY PREPARED?



3. WAS THE CONSULTANT KNOWLEDGEABLE ABOUT THE SUBJECT MATTER?



4. DID THE CONSULTANT CONDUCT THE VISIT WITH APPROPRIATE PROFESSIONALISM?



5. HOW WERE THE CONSULTANT'S SUGGESTIONS USEFUL?



6. HOW WERE THE MATERIALS PROVIDED USEFUL?



7. HOW COULD THE CONSULTANT OR GRIFFIN-HAMMIS ASSOCIATES IMPROVE FUTURE VISITS?



8. WITH WHAT OTHER ISSUES DO YOU DESIRE ASSISTANCE?



10. MY CONTACT INFORMATION (OPTIONAL):


NAME:


MAILING ADDRESS:

STREET: 

City:   

STATE:  State/TerritoryAlabama AL Alaska AK American Samoa AS Arizona AZ Arkansas AR California CA Colorado CO Connecticut CT Delaware DE District of Columbia DC Florida FL Georgia GA Guam GU Hawaii HI Idaho ID Illinois IL Indiana IN Iowa IA Kansas KS Kentucky KY Louisiana LA Maine ME Maryland MD Massachusetts MA Michigan MI Minnesota MN Mississippi MS Missouri MO Montana MT Nebraska NE Nevada NV New Hampshire NH New Jersey NJ New Mexico NM New York NY North Carolina NC North Dakota ND Northern Mariana Islands MP Ohio OH Oklahoma OK Oregon OR Pennsylvania PA Puerto Rico PR Rhode Island RI South Carolina SC South Dakota SD Tennessee TN Texas TX Utah UT Vermont VT Virgin Island VI Virginia VA Washington WA West Virginia WV Wisconsin WI Wyoming WY                  

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