Customer Satisfaction Survey
Sex:
Age:
Race:
1. How long have you been coming here?:
2. Is your worker able to meet with you and your family at times that are good for you?
Comments:
3.  Is your worker able to meet with you and your family at places that are good for you?
Comments:
4. Do you feel you are treated with respect by the staff of this program?
Comments:
5. Have we helped your family identify (check all that apply):
Comments:
If other,
6. What services did your family receive (check all that apply)?
7. Is there anything you do not like about our program? 
If yes, what?
8. Is your family more stable now that they have been in this program?
9. Did you learn anything you can use so you won’t need to get help next time?
10. Does your worker help you get assistance from other agencies?
11. Is it helpful to talk with your worker?
12.  Would you refer your neighbors to us?
If yes, in what way? 
If yes, what?
Comments:
Comments:
Comments:

Needs
Goals
written plan to meet goals
Parenting Skills
Computer Skills
Basic Living Skills
Job Search
Clothing/Food
Counseling
Education
Other