Stakeholder Survey 2009 - Supported Employment Family Member

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1. Are you satisfied with Friendship House's services?

Are you satisfied with Friendship House's services?   Yes No

2. How long has your family member been with Friendship House?

How long has your family member been with Friendship House?   0 - 3 Months 3 - 6 Months 6 - 9 Months 9 Months - 1 Year 1 Year - 3 Years 3 Years - 5 Years 5 Years - 10 Years Over 10 Years

3. Has your family member's life changed as a result of being with Friendship House?

Has your family member's life changed as a result of being with Friendship House?   Yes No

(Additional Comments)

4. Are our services what you expected?

Are our services what you expected?   Yes No

Why or Why Not?

5. Are Friendship House Staff Members responsive to your family member's needs?

Are Friendship House Staff Members responsive to your family member's needs?   Yes No

(Additional Comments)

6. Do they treat you with respect?

Do they treat you with respect?   Yes No

If No, please explain:

7. Do they treat your family member with respect?

Do they treat your family member with respect?   Yes No

If No, please explain:

8. Would you recommend our program to others in need of Supported Employment?

Would you recommend our program to others in need of Supported Employment?   Yes No

Why or Why Not?

9. Do you feel there are any of the following barriers to services:

	Yes	No
Environmental	*Do you feel there are any of the following barriers to services: Environmental Yes	Environmental No
Attitudinal	Attitudinal Yes	Attitudinal No
Financial	Financial Yes	Financial No
Employment	Employment Yes	Employment No
Communication	Communication Yes	Communication No
Transportation	Transportation Yes	Transportation No

If yes, please explain:

10. (Optional) Your Name and Email Address*:

*Your email address will not be shared with anyone. It is intended for correspondence from NJ Friendship House only.

(Optional) Your Name and Email Address*: *Your email address will not be shared with anyone. It is intended for correspondence from NJ Friendship House only.   Name:
Email Address: