FY2026 Client Satisfaction Survey

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* 1. Mark all services your household got from our agency within the last 12 months:

LIHEAP/Heating Help

Food Pantry

Hygiene Assistance

WIC

Head Start

Early Head Start

General Information/Referral

Furnace Repair/Replace

Clothing Assistance

FaDSS (Family Development and Self Sufficiency)

Housing or Rent Assistance

Emergency Utility

Senior Home Repair

Weatherization

None

Other (please specify)

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* 2. I got the information and services I needed:

Yes

N/A

Comments

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* 3. Additional program/service I would like Community Action to offer:

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* 4. I had a positive experience when receiving services:

Yes

N/A (Does not apply)

Comments

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* 5. I was informed about other agency or community services:

YES

N/A (Does not apply)

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* 6. Are there any problems or needs you or your family faced within the last 12 months you were unable to get help with?

Yes (please list below)

If Yes please list those problems or needs

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* 7. What are the greatest challenges your household is currently facing? (Check all that apply)

Employment

Livable Wage Job

Keeping a Job

Getting food

Food Budgeting

Getting Hygiene Items (feminine products, diapers, soaps, etc)

Physical Health

Mental Health

Getting Medical Care

Health Care Costs/Bills

Budgeting

Debt

Payday Loans

Housing

Transportation

Adult Education/Training

Child Education

Safety

Legal Issues

Abuse

Substance Use

Finding Childcare

Paying for Child Care

Child Care During Hours Needed

Other (please specify)

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* 8. What is one suggestion you have for Community Action to improve on?

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* 9. How has Community Action made a difference in your life?

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* 10. What county do you live in?

Des Moines

Henry

Lee

Louisa

Muscatine

Washington

Other (please specify)

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* 11. Date

Date / Time

Date

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* 12. Optional: Would you be willing to share your story?

Yes

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* 13. Optional: If you're willing to share your story, please provide your contact information.

Name

Email Address

Phone Number

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* 1. Mark all services your household got from our agency within the last 12 months:

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* 2. I got the information and services I needed:

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* 3. Additional program/service I would like Community Action to offer:

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* 4. I had a positive experience when receiving services:

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* 5. I was informed about other agency or community services:

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* 6. Are there any problems or needs you or your family faced within the last 12 months you were unable to get help with?

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* 7. What are the greatest challenges your household is currently facing? (Check all that apply)

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* 8. What is one suggestion you have for Community Action to improve on?

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* 9. How has Community Action made a difference in your life?

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* 10. What county do you live in?

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* 11. Date

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* 12. Optional: Would you be willing to share your story?

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* 13. Optional: If you're willing to share your story, please provide your contact information.

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* 14. Optional: Other Comments