Stakeholder Comments

Hideme

Accreditation Cycle ID

Organization Number

Stage

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This form is an opportunity for you to anonymously comment on your experiences with

SCAN, Inc.

Your responses will be made available for the independent Peer Review team that is evaluating this organization.

Please refrain from entering any sensitive or protected health information

Please indicate your primary relationship with this organization

Staff (Personnel, Supervisors and Managers)Consumers (Program Participants, Parents/Guardians, etc.)Governing Body (Board of Directors/Trustees, etc.)Advisory BodyCommunity Organizations (Funders, Supporters, etc.)EAP (Employee Assistance Program - affiliates or stakeholders)Network Providers and Independent Contractors

You selected 'Staff'. Which most closely describes your role

PersonnelSupervisor/Manager

You selected 'Consumers'. Which most closely describes you

Program Participant/UserYouth/Child in Foster CareYouth/Child in Residential CareYouth/Child in Ambulatory Programs Foster ParentsNetwork Consumers

You selected 'EAP'. Which most closely describes your relationship

AffiliateStakeholder

You selected 'Community Organization'. Which most closely describes your relationship

FunderOther

Please provide any comments you wish to help inform the independent Peer Review team.

Would you like to be contacted by the Peer Review team as part of this process?
(Requesting contact does not guarantee that you will be contacted)

Yes, I would like to be contacted and will provide my contact information.No, I wish to remain anonymous

Please provide your Name and your email address and/or phone number.