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* 1. Please provide your name and address.

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* 2. What is your Job Coach's name?

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* 3. Why did you pick TDI to help you find a job?

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* 4. Describe the challenges you had trying to find a job on your own?

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* 5. Describe how your TDI Employment Consultant assisted you to overcome these challenges?

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* 6. On average, how often do you and your job coach communicate (meet/VP/text/email/talk/Skype) each month?  

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* 7. I feel empowered, engaged and respected by my job coach

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* 8. I feel that my job coach’s support helped me to get a job

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* 9. I participated in creating a YEP (Your Employment Plan) with my job coach.  I have a copy detailing helpful information (phone numbers, supervisor’s names, important company policies, benefits information, etc.) that I may need to keep my job.

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* 10. I feel like I am getting the support that I need to keep my job from my job coach

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* 11. What kind help are you getting from your job coach to help you keep your job? Please circle all that apply

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* 12. Tell us how your life has changed since getting a job (talk about friends, money/finances, self- confidence, independence etc.)?

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* 13. On a scale of 1-5, with 5 being very happy and 1 being very unhappy, how happy are you with help that you have gotten from your job coach?

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* 14. On a scale of 1-5 with 5 being very satisfied and 1 being very unsatisfied how would you rate our services?

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* 15. Below, please list any ideas you have on how we can better help and serve you

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