Date:	Branch: Jeffersonville Narrowsburg Callicoon
First Name: Last Name:	Phone:
Address:	Email:
City: State: Zip:

1. Who assisted you? Cindy PatrickOther

2. In visiting the PCC, what sort of assistance were you looking for? Learning new skills Improving Existing Skills Help with a specific problem

3. Please give us a brief description of why you visited the PCC:

4. Please rate your computer skills: Novice - Never turned it on, but would really like to learn Beginner - Use a computer, but not familiar with how different programs work together Intermediate - Proficient, but always feel there is more to learn

5. Do you own a computer? Yes No

6. Do you have internet access? Yes No

7. Did the PCC help you? Yes No Not sure

8. Would you come back to the PCC? Yes No Not sure

9. Would you recommend the PCC to a friend? Yes No Not sure

10. Any additional suggestions or comments?