Community Action Center Service Satisfaction Survey

1.Date of visit to Community Action Center?(Required.)

Date / Time

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

2.Which Department did you meet with?(Required.)

Energy Assistance/Utility assistance

Section 8 Housing Choice Voucher

Weatherization/Repairs

Housing Assistance/ Rent/ Security Deposit/ Homeless

Food Bank/ Food Stamp enrollment

CAC Rental Properties

Other (please specify)

3.I received services, information, or a referral that helped my situation.(Required.)

4.What kind of help did you RECEIVE from Community Action Center, if any?(Required.)

Other (please specify)

5.The staff person helped me understand the program or services & guidelines, as well as eligibility requirements.(Required.)

6.If Community Action Center could not provide the help needed, the staff person helped with a referral for services elsewhere.(Required.)

7.I was informed of other services offered at Community Action Center.(Required.)

8.Please list unmet need(s) here:

10.Anything else? Please tell us one thing that would have made your experience better, or any other feedback or comments.
If you would like us to contact you about unmet needs,
please provide Name, Phone and/or Email

Community Action Center Service Satisfaction Survey

Please let us know how we did!