* 1. Survey administered by:

* 2. Please enter the date you completed this survey:

* 3. Where did you access Tu Casa's services?

* 4. What services did Tu Casa provide for you? Please check all that apply.

* 5. How satisfied were you with Tu Casa's services?

* 6. Did Tu Casa helped you meet the following needs?:

Food & Supplies
Mental Healthcare

* 7. Please answer the following questions:

  Yes No N/A
Were you treated with respect, fairness, and dignity while receiving services at Tu Casa?
Did you receive services/assistance in a timely manner?
Did you feel there were adequate accommodations made for language, disabilities, etc?
Did our advocate/counselor inform you about other available social services/resources?
Do you feel safer as a result of our services?
Do you know more about your rights and options as a result of our services?
Do you know more ways to plan for your safety and more about community resources?
Do you feel less alone in your experience, more confident that you will achieve your goals, and more hopeful about the future?
Were Tu Casa's services easy to access or obtain?

* 8. How did you find out about Tu Casa?

* 9. Will you come back to Tu Casa in the future?

* 10. Would you recommend our agency to others?

* 11. What are you doing differently in your life as a result of receiving Tu Casa's services?

* 12. Comments about services you received at Tu Casa: