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f C r ' .� City of South Bend The Century Center <br /> ;F �, Minority and Women-Owned Business 120 South Saint Joseph Street <br /> (� t Outreach Program: Breaking Down South Bend,IN 46601 <br /> '��� �_ tY�•, �` Barriers Diversity Outreach Event <br /> M.. S.-'` Thursday, October 18,2012 8:00 am— 11:00 am <br /> EVENT SURVEY FORM <br /> Date: , 2012 <br /> CONTACT INFORMATION <br /> Company Name: <br /> Address: State: Zip: <br /> Contact: Title: <br /> Phone: Email: <br /> If your company is certified as either a Minority or Women-Owned Business, address the following and <br /> attach a copy of your letter of certification from the following agencies, as applicable. <br /> ❑ MBE Certified By: ❑State of Indiana <br /> ❑ Indiana Minority Supplier Development Council (IMSDC) <br /> ❑WBE Certified By: ❑ State of Indiana <br /> ❑Women's Business Enterprise Council-Great Lakes(WBEC-GL) <br /> Rating Key: (5)-Strongly Agree (4)-Agree (3)-Neutral (2)-Disagree (1)-Strongly Disagree <br /> SPEAKERS <br /> Possessed sufficient expertise and were knowledgeable ❑ 5 ❑4 ❑3 ❑2 ❑ 1 <br /> Successfully conveyed the information ❑ 5 ❑4 ❑ 3 ❑2 ❑ 1 <br /> REPRESENTATIVES FROM CITY DEPARTMENTS AND/OR RESOURCE AGENCIES <br /> Addressed questions or concerns that were presented ❑5 ❑4 ❑3 ❑2 ❑ 1 <br /> Provided useful information and/or materials ❑5 ❑4 ❑3 ❑2 ❑ 1 <br /> OVERALL RATING <br /> The Outreach Event was: ❑ Excellent ❑ Very Good ❑ Good ❑ Fair ❑ Poor <br /> WHAT WOULD YOU LIKE TO SEE PROVIDED IN FUTURE UPCOMING OUTREACH EVENTS? <br /> ADDITIONAL COMMENTS <br /> Please return the completed form to the designated location designated at the <br /> Breaking Down Barriers Diversity Outreach Event or to: <br /> I Kareemah Fowler,Office of City Clerk,227 W.Jefferson Blvd. <br /> i Room 455,County-City Building,South Bend, IN. <br /> For more information,please contact Trinal,Inc.at 312-738-0500 or tdavis(a.trinalinc.com. <br />