Client Satisfaction Survey

How Are We Doing?

We're committed to monitoring the quality of the services and products we provide, as part of an ongoing improvement process. We would appreciate your feedback on our performance. All submissions are confidential and do not affect benefits and services received.

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* 1. What County do you live in?

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* 2. What was the purpose of your visit/call? (optional)

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* 3. How did you learn about CCAA? (word-of-mouth, newspaper, radio, online, etc.)

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* 4. What CCAA services have you utilized as a client?

Utility Assistance

Income Tax Assistance

Mortgage/Rental Assistance

Employment & Training

Financial Literacy/Budget Help

Payee Services

Head Start

Early Head Start

Veteran Services

Volunteer Services

Other (please specify)

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* 5. Please rank the following aspects of your visit to/ contact with Cornerstone Community Action Agency.

	Yes	No	N/A
The office was easy to find, well marked, & convenient	The office was easy to find, well marked, & convenient Yes	The office was easy to find, well marked, & convenient No	The office was easy to find, well marked, & convenient N/A
The CCAA office was clean, tidy, & comfortable	The CCAA office was clean, tidy, & comfortable Yes	The CCAA office was clean, tidy, & comfortable No	The CCAA office was clean, tidy, & comfortable N/A
I met with staff at or near the time of my appointment	I met with staff at or near the time of my appointment Yes	I met with staff at or near the time of my appointment No	I met with staff at or near the time of my appointment N/A
I didn't have an appointment, but was served in a timely manner	I didn't have an appointment, but was served in a timely manner Yes	I didn't have an appointment, but was served in a timely manner No	I didn't have an appointment, but was served in a timely manner N/A
Staff were courteous, respectful, friendly, and helpful	Staff were courteous, respectful, friendly, and helpful Yes	Staff were courteous, respectful, friendly, and helpful No	Staff were courteous, respectful, friendly, and helpful N/A
Staff was sensitive to my situation and needs	Staff was sensitive to my situation and needs Yes	Staff was sensitive to my situation and needs No	Staff was sensitive to my situation and needs N/A
My need or reason for today's visit was/ will be taken care of	My need or reason for today's visit was/ will be taken care of Yes	My need or reason for today's visit was/ will be taken care of No	My need or reason for today's visit was/ will be taken care of N/A
CCAA could not meet my need(s), but I was referred to other provider(s)	CCAA could not meet my need(s), but I was referred to other provider(s) Yes	CCAA could not meet my need(s), but I was referred to other provider(s) No	CCAA could not meet my need(s), but I was referred to other provider(s) N/A
Staff offered information about other services available	Staff offered information about other services available Yes	Staff offered information about other services available No	Staff offered information about other services available N/A
CCAA helps improve the condition in which low-income people live	CCAA helps improve the condition in which low-income people live Yes	CCAA helps improve the condition in which low-income people live No	CCAA helps improve the condition in which low-income people live N/A

Comments

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* 6. Since participating in CCAA services, are you and your family:

more self-supporting

less self-supporting

no change

prefer not to answer

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* 7. Overall, how do you rate the quality of services we provide?

Excellent

Good

Adequate

Poor

Unacceptable

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* 8. What level of confidence do you have in us to deliver the services that you require?

Complete

A lot

Some

Little

None

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* 9. Would you be interested in sharing your story with others?

Yes

Not Sure

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* 10. If yes, please share below and fill out the contact information following

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* 11. Contact Information (OPTIONAL)

Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number