Copy of Family Satisfaction Survey

	Excellent	Good	Adequate	Poor	Unacceptable
Understanding the needs of your family member	Understanding the needs of your family member Excellent	Understanding the needs of your family member Good	Understanding the needs of your family member Adequate	Understanding the needs of your family member Poor	Understanding the needs of your family member Unacceptable
Keeping you informed of progress	Keeping you informed of progress Excellent	Keeping you informed of progress Good	Keeping you informed of progress Adequate	Keeping you informed of progress Poor	Keeping you informed of progress Unacceptable
Providing good information for making choices	Providing good information for making choices Excellent	Providing good information for making choices Good	Providing good information for making choices Adequate	Providing good information for making choices Poor	Providing good information for making choices Unacceptable
Working with you and your family member to meet their goals	Working with you and your family member to meet their goals Excellent	Working with you and your family member to meet their goals Good	Working with you and your family member to meet their goals Adequate	Working with you and your family member to meet their goals Poor	Working with you and your family member to meet their goals Unacceptable
Providing staff that are dedicated and well trained	Providing staff that are dedicated and well trained Excellent	Providing staff that are dedicated and well trained Good	Providing staff that are dedicated and well trained Adequate	Providing staff that are dedicated and well trained Poor	Providing staff that are dedicated and well trained Unacceptable
Responding promptly to problems	Responding promptly to problems Excellent	Responding promptly to problems Good	Responding promptly to problems Adequate	Responding promptly to problems Poor	Responding promptly to problems Unacceptable
Promoting opportunities for inclusion in the community	Promoting opportunities for inclusion in the community Excellent	Promoting opportunities for inclusion in the community Good	Promoting opportunities for inclusion in the community Adequate	Promoting opportunities for inclusion in the community Poor	Promoting opportunities for inclusion in the community Unacceptable

Excellent

Good

Adequate

Poor

Unacceptable

Understanding the needs of your family member

Understanding the needs of your family member Excellent

Understanding the needs of your family member Good

Understanding the needs of your family member Adequate

Understanding the needs of your family member Poor

Understanding the needs of your family member Unacceptable

Keeping you informed of progress

Keeping you informed of progress Excellent

Keeping you informed of progress Good

Keeping you informed of progress Adequate

Keeping you informed of progress Poor

Keeping you informed of progress Unacceptable

Providing good information for making choices

Providing good information for making choices Excellent

Providing good information for making choices Good

Providing good information for making choices Adequate

Providing good information for making choices Poor

Providing good information for making choices Unacceptable

Working with you and your family member to meet their goals

Working with you and your family member to meet their goals Excellent

Working with you and your family member to meet their goals Good

Working with you and your family member to meet their goals Adequate

Working with you and your family member to meet their goals Poor

Working with you and your family member to meet their goals Unacceptable

Providing staff that are dedicated and well trained

Providing staff that are dedicated and well trained Excellent

Providing staff that are dedicated and well trained Good

Providing staff that are dedicated and well trained Adequate

Providing staff that are dedicated and well trained Poor

Providing staff that are dedicated and well trained Unacceptable

Responding promptly to problems

Responding promptly to problems Excellent

Responding promptly to problems Good

Responding promptly to problems Adequate

Responding promptly to problems Poor

Responding promptly to problems Unacceptable

Promoting opportunities for inclusion in the community

Promoting opportunities for inclusion in the community Excellent

Promoting opportunities for inclusion in the community Good

Promoting opportunities for inclusion in the community Adequate

Promoting opportunities for inclusion in the community Poor

Promoting opportunities for inclusion in the community Unacceptable

Question Title

* 2. The CLASS mission statement says:
CLASS supports the right of individuals with intellectual disabilities to
choose and lead dignified lives within the community.

Excellent

Good

Adequate

Poor

Unacceptable

Question Title

* 3. What level of confidence do you have in CLASS to provide the services and supports that you require for your family member?

Complete

A lot

Some

Little

None

Question Title

* 4. Overall, is our performance ...

Getting much better?

Getting better?

Staying at about the same level?

Getting worse?

Getting much worse?

Question Title

* 5. Based on our performance, how likely is it that you will rely on CLASS for support needs in the future?

Certain

Very likely

Somewhat likely

Unlikely

Very unlikely

Question Title

* 6. If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below or attach a page as necessary.

Question Title

* 7. Please include your phone number if you wish to be entered for the draw to win a $100.00 gift card for the restaurant of your choice. The phone number will only be used for the draw so we can contact the winner.

Copy of Family Satisfaction Survey

How Are We Doing?

Question Title

* 1. Please rate how you feel CLASS Services are performed on the following criteria:

Question Title

* 2. The CLASS mission statement says:
CLASS supports the right of individuals with intellectual disabilities to
choose and lead dignified lives within the community.

Question Title

* 3. What level of confidence do you have in CLASS to provide the services and supports that you require for your family member?

Question Title

* 4. Overall, is our performance ...

Question Title

* 5. Based on our performance, how likely is it that you will rely on CLASS for support needs in the future?

Question Title

* 6. If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below or attach a page as necessary.

Question Title

* 7. Please include your phone number if you wish to be entered for the draw to win a $100.00 gift card for the restaurant of your choice. The phone number will only be used for the draw so we can contact the winner.

Question Title

* 1. Please rate how you feel CLASS Services are performed on the following criteria:

Question Title

* 2. The CLASS mission statement says:CLASS supports the right of individuals with intellectual disabilities to choose and lead dignified lives within the community.

Question Title

* 3. What level of confidence do you have in CLASS to provide the services and supports that you require for your family member?

Question Title

* 4. Overall, is our performance ...

Question Title

* 5. Based on our performance, how likely is it that you will rely on CLASS for support needs in the future?

Question Title

* 6. If you have any suggestions regarding how we could improve the services we provide to you, please enter them in the box below or attach a page as necessary.

Question Title

* 7. Please include your phone number if you wish to be entered for the draw to win a $100.00 gift card for the restaurant of your choice. The phone number will only be used for the draw so we can contact the winner.

* 2. The CLASS mission statement says:
CLASS supports the right of individuals with intellectual disabilities to
choose and lead dignified lives within the community.