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Location and Service(s)

Please take a few moments to provide us with your feedback, comments and/or concerns by filling out the following survey. Thank you for taking the time to help improve our customer service!

Question Title

* 1. Date of Service / Date of Interaction


Question Title

* 3. I was assisted with the following services:

  CalFresh General Relief Medi-Cal CalWORKs GAIN or Child Care Services Workforce Connection (WFC)
I'm Applying for:
I'm Receiving: