Customer Satisfaction Survey Please take a couple of minutes to complete this Customer Satisfaction Survey. Your comments will help us gauge just how well we perform and will enable use to improve your customer experience. Once you have completed all the questions, please click on the "Submit" button at the bottom of the survey. Question Title * 1. Date of Service Date: Date Question Title * 2. Which of our program(s) did you visit? After School Programs Business Start-Up Assistance Finding Child Care Starting a Day Care Children’s Respite Community Action Angels Domestic Violence Services Emergency Food Pantries Head Start & Early Head Start Homelessness / Foreclosure Prevention Homeownership Assistance Owner-Occupied Home Repair Section 8 Rental Assistance Wheels for Work Vehicle Loans Workforce Development-ASSET Program Question Title * 3. Please rate your level of agreement or disagreement with the following statements: Agree Disagree I was listened to and treated with respect. I was listened to and treated with respect. Agree I was listened to and treated with respect. Disagree I received the help I needed. I received the help I needed. Agree I received the help I needed. Disagree I was provided with information and or referrals to other services. I was provided with information and or referrals to other services. Agree I was provided with information and or referrals to other services. Disagree I found the environment to be friendly and comfortable. I found the environment to be friendly and comfortable. Agree I found the environment to be friendly and comfortable. Disagree I found it easy to find the correct site or building. I found it easy to find the correct site or building. Agree I found it easy to find the correct site or building. Disagree Question Title * 4. Is there anything about your experience today that you would like to share? Question Title * 5. Please leave your name and phone number if you would like a follow up call to discuss the customer service experience you had today. Question Title * 6. ACCORD STAFF ONLY: Responses entered into SurveyMonkey Yes No Submit response
