Exit Interview

1. Default Section

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1. Was this the first time that you placed a child with us?

Was this the first time that you placed a child with us? Yes

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2. Was your Monthly Summary given to you timely each month?

Was your Monthly Summary given to you timely each month? Yes

Other (please specify)

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3. Did you feel the staff were responsive to your needs?

Did you feel the staff were responsive to your needs? Yes

Other (please specify)

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4. What did you like about the Angel House?

What did you like about the Angel House? Location

Staff

Services

Other (please specify)

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5. How would you rate us overall on these services

	Poor	Moderate	High	Exceed
Intake	*How would you rate us overall on these services Intake Poor	Intake Moderate	Intake High	Intake Exceed
Communication	Communication Poor	Communication Moderate	Communication High	Communication Exceed
Availability	Availability Poor	Availability Moderate	Availability High	Availability Exceed
Service Delivery	Service Delivery Poor	Service Delivery Moderate	Service Delivery High	Service Delivery Exceed

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6. Please rate us in the following areas

	Poor	Fair	High	Exceed
Access to your child	*Please rate us in the following areas Access to your child Poor	Access to your child Fair	Access to your child High	Access to your child Exceed
Safety of your child	Safety of your child Poor	Safety of your child Fair	Safety of your child High	Safety of your child Exceed
Security of the home	Security of the home Poor	Security of the home Fair	Security of the home High	Security of the home Exceed
Cleanliness of the home	Cleanliness of the home Poor	Cleanliness of the home Fair	Cleanliness of the home High	Cleanliness of the home Exceed

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7. Did you encounter any problems with your child while in our care?

Did you encounter any problems with your child while in our care? Yes

Other (please specify)

If yes, please tell me more here.

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8. Would you place a child with us again?

Would you place a child with us again? Yes

Other (please specify)

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9. Where was your child's next stop?

Where was your child's next stop? Home with family or relative

A Foster Family

A PRTF

Emancipation

Other

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Exit Interview

1. Default Section

*1. Was this the first time that you placed a child with us?

*2. Was your Monthly Summary given to you timely each month?

*3. Did you feel the staff were responsive to your needs?

*4. What did you like about the Angel House?

*5. How would you rate us overall on these services

*6. Please rate us in the following areas

*7. Did you encounter any problems with your child while in our care?

*8. Would you place a child with us again?

*9. Where was your child's next stop?

*
1. Was this the first time that you placed a child with us?

*
2. Was your Monthly Summary given to you timely each month?

*
3. Did you feel the staff were responsive to your needs?

*
4. What did you like about the Angel House?

*
5. How would you rate us overall on these services

*
6. Please rate us in the following areas

*
7. Did you encounter any problems with your child while in our care?

*
8. Would you place a child with us again?

*
9. Where was your child's next stop?