SA/LA - User Response, Feedback, and Request Forms

Attachment 7

TAKE ACTION: TO MAKE A DIFFERENCE! Web Resource Feedback Form

USDA/Food and Nutrition Service (FNS)

Tell us what you think! Please take a moment to review the USDA/FNS TAKE ACTION web resource, Take Action: Promote and Support Breastfeeding Across FNS Programs, and then transmit your comments to FNS by pushing the “Submit” button.

Please check one: I am employed at: ____State level FNS Program office ____Local level FNS program office

Would you like FNS to develop web resources on other topics? ____Yes ____No

If “Yes,” list the topic(s):__________________________________________________

1. Are you planning to use the tips on the web resource: ____Yes ____No

2. If Yes, how will you use the web resource (choose one or more)?

   1. ____Share it with my colleagues

   2. ____Use ideas to plan events and programs in my setting to promote breastfeeding

   3. ____To encourage other staff to plan events and programs to promote breastfeeding

   4. ____Use in planning SNAP

   5. ____Other (explain)_____________________________________________________

3. If No, why not?___________________________________________________________________

4. How useful are the supporting links to other resources on the web resource?

Very useful____ Moderately useful____ Slightly useful____ Not useful at all____

5. What do you like best about this web resource?

6. What did you like least about this web resource?

7. Other comments:

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