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The purpose of this survey is to  improve services. Thank you for participating. 

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* 1. Which site did you visit?

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* 2. Were the office and waiting area clean? 

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* 3. Were you assisted promptly? 

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* 4. Were you treated with respect?

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* 5. Which programs did you participate in? Please select all that apply.

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* 6. How would you rate the quality of the services you received? [Scale from poor (1) to excellent (5)]

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* 7. Did staff offer additional information about other Community Action Programs for which you might be eligible? 

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* 8. How would you rate the staff members’ overall knowledge of the program? [Scale from poor (1) to excellent (5)]

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* 9. Based on the services the program could provide, please rate if your needs were met? [Scale from 1= None of my needs have been met to 5= All of my needs have been met]

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* 10. Since receiving services are you better able to meet your or your family’s needs? 

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* 11. Have you or a family member ever needed a service but found it was unavailable in our area? If so, please describe below.

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* 12. Would you recommend this program, if a family member or friend was in need of similar help?

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* 13. Would you recommend Newcap, if a family member or friend was in need of help?

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* 14. Would you return to use our services next season if you were still eligible?

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* 15. If you have any further comments or concerns, please let us know in the space below.

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* 16. If you would like us to follow up with you, please leave your contact information:

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