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Community Needs Assessment

  1. Family Resource Center Community Needs Assessment
    Franklin County Family Resource Center
    P. O. Box 188
    Rocky Mount, VA 24151
    Phone 540-483-5088
    24 Hour Hotline 540-483-1234

    Please take a moment to answer the following questions to assist us with our Community Needs Assessment.

  2. Gender

  3. How did you hear of our services? (Check all that apply)

  4. Have you ever been in an abusive relationship?

  5. If you have been in an abusive relationship, check all options that kept you from leaving the relationship.

  6. Have you ever known someone that was in an abusive relationship?

  7. If you have known someone that was in an abusive relationship, check all options that kept them from leaving the relationship.

  8. Leave This Blank:

  9. This field is not part of the form submission.