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A Place of Our Own Clubhouse
Your comments are important to us. Please take a moment to fill out this survey.
How strongly do you agree or disagree with each of the following statements?
OK
1.
I like the services that I receive.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
2.
I have access to the program during times other than usual work day hours including evenings, weekends, and holidays.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
3.
I have access to all of the program activities.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
4.
I am able to make my own schedule.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
5.
I am a part of all of the decisions made at the program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
6.
I work side-by-side with staff to accomplish tasks and activities in the program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
7.
I actively participate in (scheduled) planned program activities and am able to choose what I want to do.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8.
I feel the work and activities I do in the program are meaningful/ significant.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
9.
I receive educational services/ resources/supports in the program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
10.
I receive employment services/ resources/supports in the program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
11.
I have opportunities to give and receive support locating community resources.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
12.
I have opportunities to participate in activities that promote my physical well being.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
13.
I deal more effectively with daily problems.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
14.
I am better able to establish and maintain positive relationships.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
15.
I am better able to deal with crisis.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
16.
I am developing a better self-image.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
17.
I feel more optimistic (hopeful) about the future.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
18.
I feel connected to the community through the activities provided by the program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
19.
I am managing my symptoms better.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
20.
The comments I want to make about the program and services I received are: