Recovery Month Kit

Customer Satisfaction Form

Download the PDF version of the "Customer Satisfaction Form" (326 KB).

We would like to know about your National Alcohol and Drug Addiction Recovery Month (Recovery Month) efforts this September and how useful you found this toolkit for planning your activities. This information will be used in the development of future outreach materials distributed by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT).

Your response is voluntary, but your input is essential so that the Recovery Month materials we provide in future years will continue to meet your needs. We encourage you to include photographs and/or samples of supporting materials from your Recovery Month activities.

* indicates a required field.

Name:

Title:

Organization Name:

Your Role:

Event Planner
Researcher
Policy Specialist
Treatment/Recovery Provider
Event Participant
General Audience
Other:

Other Role-Specify:

How did you use other Recovery Month materials? Or, provide any other feedback:

Mailing Address:

Phone: Example: xxx-xxx-xxxx

Fax:

Organization web site address:

E-mail address:

Please provide a brief description of your event or major activities. (Please attach additional sheets, if necessary.)

Attach Documents:

Did you receive media coverage?	YesNo

If yes, who covered your event? (Please attach a brief summary or copies of articles.)

Attach Documents:

Online Materials	Used It?	How Useful Was it?	Comments/Suggestions
Planning Your *Recovery Month* Event	YesNo	Very Useful Useful Not Useful	Comments
A Guide to *Recovery Month* Publicity and Media Interviews	YesNo	Very Useful Useful Not Useful	Comments
Press Materials for Your *Recovery Month* Event	YesNo	Very Useful Useful Not Useful	Comments
Drafting and Submitting an Op-Ed During *Recovery Month*	YesNo	Very Useful Useful Not Useful	Comments
Official *Recovery Month* Proclamations	YesNo	Very Useful Useful Not Useful	Comments
Promoting *Recovery Month* With Public Service Announcements	YesNo	Very Useful Useful Not Useful	Comments
Banners, Letterhead, and Logos	YesNo	Very Useful Useful Not Useful	Comments
An Overview: Now More Than Ever!	YesNo	Very Useful Useful Not Useful	Comments
Addressing Substance Use Disorders and Stress Among Public Safety Officials	YesNo	Very Useful Useful Not Useful	Comments
Addressing Substance Use Disorders and Stress in the Workplace	YesNo	Very Useful Useful Not Useful	Comments
Stress and Substance Use Disorders in Families	YesNo	Very Useful Useful Not Useful	Comments
Development of Substance Use Disorders in Older Adults	YesNo	Very Useful Useful Not Useful	Comments
Treatment and Recovery: Finding Specialized Help for Substance Use Disorders	YesNo	Very Useful Useful Not Useful	Comments
Commonly Misused Substances	YesNo	Very Useful Useful Not Useful	Comments
New Media Glossary	YesNo	Very Useful Useful Not Useful	Comments

Booklet Sections	Used It?	How Useful Was it?	Comments/Suggestions
Building Community Coalitions	YesNo	Very Useful Useful Not Useful	Comments
Planning Partners List	YesNo	Very Useful Useful Not Useful	Comments
*Recovery Month* Resources	YesNo	Very Useful Useful Not Useful	Comments
Single-State Agency Directory	YesNo	Very Useful Useful Not Useful	Comments
Online Voices for Recovery	YesNo	Very Useful Useful Not Useful	Comments
Targeted Outreach Booklet	YesNo	Very Useful Useful Not Useful	Comments
Commonly Misused Substances Handout	YesNo	Very Useful Useful Not Useful	Comments

NOTE: Public reporting for this collection of information is estimated to average 10 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: SAMHSA Reports Clearance Officer, Paperwork Reduction Project (0930-0197); Room 5-1039, 1 Choke Cherry Road, Second Floor, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0197 and the expiration date is 1/31/2011.

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The Recovery Month effort aims to promote the societal benefits of alcohol and drug use disorder treatment, laud the contributions of treatment providers, and promote the message that recovery from alcohol and drug use disorders in all its forms is possible.

Materials and events posted on the National Alcohol and Drug Addiction Recovery Month (Recovery Month) Web site are solely the responsibility of the authors and do not necessarily represent the official views the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration or the Center for Substance Abuse Treatment.