Client Survey

	Yes	Somewhat	No	N/A	?
My advocate listened to my concerns about my situation.	My advocate listened to my concerns about my situation. Yes	My advocate listened to my concerns about my situation. Somewhat	My advocate listened to my concerns about my situation. No	My advocate listened to my concerns about my situation. N/A	My advocate listened to my concerns about my situation. ?
My advocate helped me figure out where I might receive the services I need. (Referral)	My advocate helped me figure out where I might receive the services I need. (Referral) Yes	My advocate helped me figure out where I might receive the services I need. (Referral) Somewhat	My advocate helped me figure out where I might receive the services I need. (Referral) No	My advocate helped me figure out where I might receive the services I need. (Referral) N/A	My advocate helped me figure out where I might receive the services I need. (Referral) ?
Project SAFE personnel were supportive and informative.	Project SAFE personnel were supportive and informative. Yes	Project SAFE personnel were supportive and informative. Somewhat	Project SAFE personnel were supportive and informative. No	Project SAFE personnel were supportive and informative. N/A	Project SAFE personnel were supportive and informative. ?
My Advocate helped me figure out how to be safer.	My Advocate helped me figure out how to be safer. Yes	My Advocate helped me figure out how to be safer. Somewhat	My Advocate helped me figure out how to be safer. No	My Advocate helped me figure out how to be safer. N/A	My Advocate helped me figure out how to be safer. ?
I have more information regarding why/how domestic violence happens.	I have more information regarding why/how domestic violence happens. Yes	I have more information regarding why/how domestic violence happens. Somewhat	I have more information regarding why/how domestic violence happens. No	I have more information regarding why/how domestic violence happens. N/A	I have more information regarding why/how domestic violence happens. ?
I received assistance with a protection order.	I received assistance with a protection order. Yes	I received assistance with a protection order. Somewhat	I received assistance with a protection order. No	I received assistance with a protection order. N/A	I received assistance with a protection order. ?
I received assistance preparing to give court testimony.	I received assistance preparing to give court testimony. Yes	I received assistance preparing to give court testimony. Somewhat	I received assistance preparing to give court testimony. No	I received assistance preparing to give court testimony. N/A	I received assistance preparing to give court testimony. ?
I am aware of my rights as a victim of crime.	I am aware of my rights as a victim of crime. Yes	I am aware of my rights as a victim of crime. Somewhat	I am aware of my rights as a victim of crime. No	I am aware of my rights as a victim of crime. N/A	I am aware of my rights as a victim of crime. ?
I am aware that I may be eligible for victim compensation or restitution.	I am aware that I may be eligible for victim compensation or restitution. Yes	I am aware that I may be eligible for victim compensation or restitution. Somewhat	I am aware that I may be eligible for victim compensation or restitution. No	I am aware that I may be eligible for victim compensation or restitution. N/A	I am aware that I may be eligible for victim compensation or restitution. ?
I received assistance filling out victim compensation paperwork.	I received assistance filling out victim compensation paperwork. Yes	I received assistance filling out victim compensation paperwork. Somewhat	I received assistance filling out victim compensation paperwork. No	I received assistance filling out victim compensation paperwork. N/A	I received assistance filling out victim compensation paperwork. ?
My advocate explained the next step in the court process for me.	My advocate explained the next step in the court process for me. Yes	My advocate explained the next step in the court process for me. Somewhat	My advocate explained the next step in the court process for me. No	My advocate explained the next step in the court process for me. N/A	My advocate explained the next step in the court process for me. ?
I understand I have the right to submit a victim impact statement.	I understand I have the right to submit a victim impact statement. Yes	I understand I have the right to submit a victim impact statement. Somewhat	I understand I have the right to submit a victim impact statement. No	I understand I have the right to submit a victim impact statement. N/A	I understand I have the right to submit a victim impact statement. ?

Yes

Somewhat

N/A

My advocate listened to my concerns about my situation.

My advocate listened to my concerns about my situation. Yes

My advocate listened to my concerns about my situation. Somewhat

My advocate listened to my concerns about my situation. No

My advocate listened to my concerns about my situation. N/A

My advocate listened to my concerns about my situation. ?

My advocate helped me figure out where I might receive the services I need. (Referral)

My advocate helped me figure out where I might receive the services I need. (Referral) Yes

My advocate helped me figure out where I might receive the services I need. (Referral) Somewhat

My advocate helped me figure out where I might receive the services I need. (Referral) No

My advocate helped me figure out where I might receive the services I need. (Referral) N/A

My advocate helped me figure out where I might receive the services I need. (Referral) ?

Project SAFE personnel were supportive and informative.

Project SAFE personnel were supportive and informative. Yes

Project SAFE personnel were supportive and informative. Somewhat

Project SAFE personnel were supportive and informative. No

Project SAFE personnel were supportive and informative. N/A

Project SAFE personnel were supportive and informative. ?

My Advocate helped me figure out how to be safer.

My Advocate helped me figure out how to be safer. Yes

My Advocate helped me figure out how to be safer. Somewhat

My Advocate helped me figure out how to be safer. No

My Advocate helped me figure out how to be safer. N/A

My Advocate helped me figure out how to be safer. ?

I have more information regarding why/how domestic violence happens.

I have more information regarding why/how domestic violence happens. Yes

I have more information regarding why/how domestic violence happens. Somewhat

I have more information regarding why/how domestic violence happens. No

I have more information regarding why/how domestic violence happens. N/A

I have more information regarding why/how domestic violence happens. ?

I received assistance with a protection order.

I received assistance with a protection order. Yes

I received assistance with a protection order. Somewhat

I received assistance with a protection order. No

I received assistance with a protection order. N/A

I received assistance with a protection order. ?

I received assistance preparing to give court testimony.

I received assistance preparing to give court testimony. Yes

I received assistance preparing to give court testimony. Somewhat

I received assistance preparing to give court testimony. No

I received assistance preparing to give court testimony. N/A

I received assistance preparing to give court testimony. ?

I am aware of my rights as a victim of crime.

I am aware of my rights as a victim of crime. Yes

I am aware of my rights as a victim of crime. Somewhat

I am aware of my rights as a victim of crime. No

I am aware of my rights as a victim of crime. N/A

I am aware of my rights as a victim of crime. ?

I am aware that I may be eligible for victim compensation or restitution.

I am aware that I may be eligible for victim compensation or restitution. Yes

I am aware that I may be eligible for victim compensation or restitution. Somewhat

I am aware that I may be eligible for victim compensation or restitution. No

I am aware that I may be eligible for victim compensation or restitution. N/A

I am aware that I may be eligible for victim compensation or restitution. ?

I received assistance filling out victim compensation paperwork.

I received assistance filling out victim compensation paperwork. Yes

I received assistance filling out victim compensation paperwork. Somewhat

I received assistance filling out victim compensation paperwork. No

I received assistance filling out victim compensation paperwork. N/A

I received assistance filling out victim compensation paperwork. ?

My advocate explained the next step in the court process for me.

My advocate explained the next step in the court process for me. Yes

My advocate explained the next step in the court process for me. Somewhat

My advocate explained the next step in the court process for me. No

My advocate explained the next step in the court process for me. N/A

My advocate explained the next step in the court process for me. ?

I understand I have the right to submit a victim impact statement.

I understand I have the right to submit a victim impact statement. Yes

I understand I have the right to submit a victim impact statement. Somewhat

I understand I have the right to submit a victim impact statement. No

I understand I have the right to submit a victim impact statement. N/A

I understand I have the right to submit a victim impact statement. ?

Question Title

* 2. Because of the Advocacy/Support Services I received from Project SAFE: (check all that apply)

I know more ways to plan for my safety.

I know more about community resources.

I know more about my rights and options.

I am more hopeful about the future.

I am more comfortable asking for assistance.

I am more confident in my decision making.

I feel empowered to accomplish the goals I have set for myself.

Question Title

* 3. Please indicate the selection that best describes your experience:

	N/A	Yes	Somewhat	No
I was treated with respect.	I was treated with respect. N/A	I was treated with respect. Yes	I was treated with respect. Somewhat	I was treated with respect. No
Staff was caring and supportive.	Staff was caring and supportive. N/A	Staff was caring and supportive. Yes	Staff was caring and supportive. Somewhat	Staff was caring and supportive. No
We spent sufficient time discussing my safety.	We spent sufficient time discussing my safety. N/A	We spent sufficient time discussing my safety. Yes	We spent sufficient time discussing my safety. Somewhat	We spent sufficient time discussing my safety. No
My religious/spiritual beliefs were respected.	My religious/spiritual beliefs were respected. N/A	My religious/spiritual beliefs were respected. Yes	My religious/spiritual beliefs were respected. Somewhat	My religious/spiritual beliefs were respected. No
My sexual orientation was respected.	My sexual orientation was respected. N/A	My sexual orientation was respected. Yes	My sexual orientation was respected. Somewhat	My sexual orientation was respected. No
My racial/ethnic background was respected.	My racial/ethnic background was respected. N/A	My racial/ethnic background was respected. Yes	My racial/ethnic background was respected. Somewhat	My racial/ethnic background was respected. No
Any special needs related to disability were addressed.	Any special needs related to disability were addressed. N/A	Any special needs related to disability were addressed. Yes	Any special needs related to disability were addressed. Somewhat	Any special needs related to disability were addressed. No
Any special needs related to my age were addressed.	Any special needs related to my age were addressed. N/A	Any special needs related to my age were addressed. Yes	Any special needs related to my age were addressed. Somewhat	Any special needs related to my age were addressed. No

Question Title

* 4. Overall, my experience with Project SAFE has been:

Very Helpful

Helpful

Somewhat Helpful

Not at all Helpful

N/A

Very Helpful

Helpful

Somewhat Helpful

Not at all Helpful

N/A

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* 5. Based on your experience, would you recommend Project SAFE to friends/family in need of similar assistance?

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* 6. About You:

	Age	Ethnicity	Sexuality	Education Level	Gender
Primary Client	Primary Client Age menu	Primary Client Ethnicity menu	Primary Client Sexuality menu	Primary Client Education Level menu	Primary Client Gender menu
Secondary Client	Secondary Client Age menu	Secondary Client Ethnicity menu	Secondary Client Sexuality menu	Secondary Client Education Level menu	Secondary Client Gender menu

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* 7. Do you have any comments, questions or concerns regarding your experience with our Program or Staff?

Question Title

* 8. Thank you for taking time to complete our survey!
If you would like to be contacted regarding your survey, please leave your information.

Name

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 1. Please indicate the level of assistance you received in each area.

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* 2. Because of the Advocacy/Support Services I received from Project SAFE: (check all that apply)

Question Title

* 3. Please indicate the selection that best describes your experience:

Question Title

* 4. Overall, my experience with Project SAFE has been:

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* 5. Based on your experience, would you recommend Project SAFE to friends/family in need of similar assistance?

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* 6. About You:

Question Title

* 7. Do you have any comments, questions or concerns regarding your experience with our Program or Staff?

Question Title

* 8. Thank you for taking time to complete our survey!If you would like to be contacted regarding your survey, please leave your information.

* 8. Thank you for taking time to complete our survey!
If you would like to be contacted regarding your survey, please leave your information.