Client Satisfaction Survey * 1. Today's Date: Date / Time MM / DD / YYYY * 2. How did you hear about QCAP? Check all that apply. Friend/Family Walk-In Newspaper/TV/Radio Flyer Online Other Agency Referred You Assigned To QCAP Other_________ * 3. Did you visit QCAP website? Check all that apply. YES NO * 4. Which QCAP program helped you? Check all that apply. ABE/Workforce Dev CCK SW Emergency Food Center Financial Reach Center Energy Head Start Housing Tax Program * 5. Was the program staff professional and courteous? YES NO * 6. Did QCAP staff provide you with information about other programs? YES NO * 7. Was the material and information helpful and clear? YES NO * 8. Would you recommend QCAP to a friend or family? YES NO * 9. Does your primary language make it difficult to use QCAP services? YES NO * 10. Your feedback is very important to us. Do you have any additional comments you would like to share? * 11. Input Survey Number Below. (For Internal Use Only) Done