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CUSTOMER FEEDBACK SURVEY | FY'26
Thank you for taking the time to tell Blue Valley Community Action (BVCA) Partnership how we are doing so that we can provide the best services possible to meet your needs.
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1.
Program or Service:
(Required.)
Blue River Early Learning Academy
CSFP - Commodity Supplemental Food Program
Emergency Assistance (rent, utilities, shelter, etc.)
Fillmore County Rural Transit
Food Pantry
Foster Grandparent Program
Head Start 0-5
Home Ownership
Housing Counseling
Housing Rentals & Lease-to-Own
Immunizations
Infant/Toddler Quality Early Childhood Initiative Program/ITQI
Owner-Occupied Rehabilitation
Project FIRST
Project FYRES
Telehealth
Thrift Store
Veterans Assistance/SSVF
Weatherization
WIC - Women, Infants & Children Program
Other (please specify):
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2.
County
(Required.)
Butler County, NE
Fillmore County, NE
Gage County, NE
Jefferson County, NE
Polk County, NE
Saline County, NE
Seward County, NE
Thayer County, NE
York County, NE
Other (please specify):
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3.
Overall, how would you rate the quality of services received as part of this program?
(Required.)
Excellent
Good
Fair
Poor
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4.
To what extent have the services provided through this program met your needs?
(Required.)
Almost all of my needs have been met.
Most of my needs have been met.
Only a few of my needs have been met.
None of my needs have been met.
If you have needs that are not being met, please describe them here:
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5.
Did staff members offer you additional information about other programs that might help you and your family?
(Required.)
Yes
No
Not sure
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6.
How would you rate staff members’ knowledge of BVCA Partnership’s programs and services?
(Required.)
Excellent
Good
Fair
Poor
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7.
Please mark your level of agreement or disagreement with the following statements:
(Required.)
Strongly agree
Agree somewhat
Neither Agree or Disagree
Disagree somewhat
Strongly disagree
Staff members treat me with respect.
Strongly agree
Agree somewhat
Neither Agree or Disagree
Disagree somewhat
Strongly disagree
I feel welcome when I visit the facility.
Strongly agree
Agree somewhat
Neither Agree or Disagree
Disagree somewhat
Strongly disagree
The facility is clean and comfortable.
Strongly agree
Agree somewhat
Neither Agree or Disagree
Disagree somewhat
Strongly disagree
Because of BVCA Partnership’s help, I have improved my situation.
Strongly agree
Agree somewhat
Neither Agree or Disagree
Disagree somewhat
Strongly disagree
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8.
Would you recommend this program or service to others?
(Required.)
Definitely yes
Probably yes
Probably no
Definitely no
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9.
How did you hear about this program or service? (Select all that apply.)
(Required.)
Family or friends
Internet
Referral from program not part of BVCA Partnership
Referral from another BVCA Partnership program
Not sure
Other (please specify)
10.
What does your family struggle with the most?
11.
What is the primary language spoken in your home?
English
Spanish
Another language (please specify):
12.
What is your age?
18-23
24-34
35-44
45-54
55-64
65-74
75 or older
13.
What is your sex?
Male
Female
14.
Are you Hispanic or Latino?
Yes
No
15.
What is your race?
African American
Asian or Pacific Island
White
Native American
Bi-Racial
Multi-Racial
Other (please specify):
16.
If you have anything else you want us to know, please use the space below.
17.
If you wish to be contacted by one of BVCA's coordinators, please provide your name & contact information below.
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
Current Progress,
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