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Service Insights - Agency Readiness
1.
What is your Agency name and ID?
2.
What is your name?
3.
What is your role at the agency?
4.
What is your email?
5.
How would you best describe your agency's current intake process? (e.g. one-on-one, waiting/welcome room/no process)
One-on-One
Waiting Room/Welcome Area
Sign up at the door
Other (please specify)
6.
How does your agency currently log information about clients? (check all that apply)
Paper and Pencil
Microsoft Excel
Google Docs
Other (please specify)
7.
What is the current number of paid staff and/or volunteers who help or could help with client intake?
8.
How many clients does your agency serve during a single distribution? (average number of households)
9.
What types of technology does your agency currently have available that could be used for client intake? (check all that apply)
Tablets
Laptops
Desktop Computer
Smartphone
Other (please specify)
10.
Do you have or use Internet Access at your program site?
Yes, we have and use Internet
Yes, we have Internet access but do not use it
No, our area is too remote
No, but WiFi is available in our area
Other (please specify)