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Ele's Place Satisfaction Survey for Adolescents

1. Satisfaction Survey

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1. We want to know how you feel about your experience at Ele's Place. Please take a few minutes to answer the following questions. NOT AT ALL means you do not agree. VERY MUCH means you agree the most.

	Not at all	Not so much	Sometimes	Mostly	Very Much
I liked coming to Ele's Place.	I liked coming to Ele's Place. Not at all	I liked coming to Ele's Place. Not so much	I liked coming to Ele's Place. Sometimes	I liked coming to Ele's Place. Mostly	I liked coming to Ele's Place. Very Much
I could talk about my feelings in my group, if I wanted to.	I could talk about my feelings in my group, if I wanted to. Not at all	I could talk about my feelings in my group, if I wanted to. Not so much	I could talk about my feelings in my group, if I wanted to. Sometimes	I could talk about my feelings in my group, if I wanted to. Mostly	I could talk about my feelings in my group, if I wanted to. Very Much
Adults in my group listened to me when I talked.	Adults in my group listened to me when I talked. Not at all	Adults in my group listened to me when I talked. Not so much	Adults in my group listened to me when I talked. Sometimes	Adults in my group listened to me when I talked. Mostly	Adults in my group listened to me when I talked. Very Much
Since coming to Ele's Place, I feel like I'm not the only one dealing with a death.	Since coming to Ele's Place, I feel like I'm not the only one dealing with a death. Not at all	Since coming to Ele's Place, I feel like I'm not the only one dealing with a death. Not so much	Since coming to Ele's Place, I feel like I'm not the only one dealing with a death. Sometimes	Since coming to Ele's Place, I feel like I'm not the only one dealing with a death. Mostly	Since coming to Ele's Place, I feel like I'm not the only one dealing with a death. Very Much
Since coming to Ele's Place, it is easier for me to talk about the person who died.	Since coming to Ele's Place, it is easier for me to talk about the person who died. Not at all	Since coming to Ele's Place, it is easier for me to talk about the person who died. Not so much	Since coming to Ele's Place, it is easier for me to talk about the person who died. Sometimes	Since coming to Ele's Place, it is easier for me to talk about the person who died. Mostly	Since coming to Ele's Place, it is easier for me to talk about the person who died. Very Much
I can deal with my feelings better since coming to Ele's Place.	I can deal with my feelings better since coming to Ele's Place. Not at all	I can deal with my feelings better since coming to Ele's Place. Not so much	I can deal with my feelings better since coming to Ele's Place. Sometimes	I can deal with my feelings better since coming to Ele's Place. Mostly	I can deal with my feelings better since coming to Ele's Place. Very Much
Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad).	Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad). Not at all	Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad). Not so much	Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad). Sometimes	Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad). Mostly	Coming to Ele's Place helped me learn things to do that help me when I'm upset (sad, mad). Very Much

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2. Your Group:

Middle School

High School

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3. How long have you been coming to Ele's Place?

1 month or less

2-4 months

5-8 months

9 months - 1 year

More than a year

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4. What was most helpful to you at Ele's Place?

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5. Was there anything at Ele's Place that you felt was NOT helpful to you? If yes, please explain.

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6. What would you change about how we do things at Ele's Place?

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7. Optional:

Name:

Name:

Email Address:

Phone Number: