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* 1. Gender

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* 2. Branch of Military Service (family members, select your veteran’s service branch and all that apply)

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* 3. What service did the assistance organization provide you?

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* 4. I feel that the things I do with the service provider will help me to accomplish my goals.

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* 5. My relationships have improved because of the skills and services I have received.

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* 6. I have more hope for a better future now, than before I asked for help.

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* 7. How satisfied are you with local service provider staff who helped you, including employee courtesy, friendliness, and knowledge, and whether staff members adequately identified themselves to you by name, including the use of name plates or tags for accountability?

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* 8. How satisfied are you with local service provider’s communications, including access to a live person, the average time you spend on hold, call transfers, letters, and electronic mail?

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* 9. How satisfied are you with the local service provider’s complaint handling process, including whether it is easy to file a complaint and whether responses are timely?

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* 10. How satisfied are you with the local service provider’s ability to timely serve you, including the amount of time you wait for service in person?

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* 11. Please rate your overall satisfaction with the local service provider.

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* 12. Is there anything else we need to know about your experience with the service provider? (Optional)

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