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CCCG 2010 Client Satisfaction Survey
Client Information
33%
1
. What is your gender?
What is your gender?
Female
Male
Transgender
Intergender
Other (please specify)
2
. What is your age range?
What is your age range?
18 years and under
18-29 years old
30-49 years old
50-64 years old
65 years and over
3
. What is the highest level of education you have completed?
What is the highest level of education you have completed?
Some high school
High School graduate
Some college
Trade/Technical/Vocational Training
College graduate
Some postgraduate work
Post graduate degree
4
. Racial/Ethnic Identity (Select all that apply)
Racial/Ethnic Identity (Select all that apply)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
5
. Please list the zipcode in which you reside.
Please list the zipcode in which you reside.
ZIP:
6
. Employment Status (Select all the apply)
Employment Status (Select all the apply)
Full-time
Part-time
Self-employed
Retired
Multiple Jobs
Student
Stay at home parent
Unemployed
7
. CCCG Counselor Center Location
CCCG Counselor Center Location
I visit a CCCG location close to my home.
I visit a CCCG location close to my work/school.
8
. I was referred to CCCG by:
I was referred to CCCG by:
Friend/Family
Minister/Church Staff
Insuance
Co-worker/EAP
Internet Search
*
9
. I became a client with CCCG:
I became a client with CCCG:
2009 or earlier
2010
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