100% of survey complete.
For each item, mark the response that best answers the question "Am I Satisfied?".

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* Name (OPTIONAL)

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* Date

Date

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* Phase of Services

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* SERVICES

  Strongly Disagree Disagree Agree Strongly Agree N/A
I like the services that I receive from this organization.
I was provided information about the organizations values and mission.
I was provided information about expected results or outcomes of services.
I was provided information about how service planning is conducted.
I was provided information about my role in setting employment goals.
I was informed that my continued participation was required.
I was actively involved in the development of my employment plan.
I feel like I have a say in my services.
My plan was understandable to me.
Staff have helped me set goals for myself.
I was informed about opportunities for employment in the local community consistent with my desired outcomes. 
Staff returned my calls.
Services were available at times and places that were good for me.
I feel comfortable asking questions about my services.
I feel free to complain when I am not satisfied.
I was given information about my rights.
Staff respect my wishes about confidentiality.
Staff help me obtain information I need concerning my needs and benefits.
I was informed about resources to assist me in securing and retaining related benefits for which I am eligible.
My Employment Counselor provides consistent, reliable services.

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* Comments:

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