*1.Which location did you visit today?(Required.)

Talladega

Sylacauga

Roanoke

Wedowee

Anniston

Piedmont

Lineville

Heflin

2.What is your gender?

Female

Male

3.Which race/ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black / African American

Hispanic

White / Caucasian

Multiple ethnicity / Other (please specify)

*4.What is your age?(Required.)

18-24

25-44

45-54

55-59

60 or older

*5.How did you find about the services offered by CAA?(Required.)

Newspaper

Radio

Internet/Social Media

Family Member

Other

6.Have you received services from CAA in the past 5 years?

Yes

No

*7.Were you referred to other agencies for services?(Required.)

Yes

No

*8.Do you feel that you were treated with courtesy and respect?(Required.)

Yes

No

*9.Did you get the type of service(s) expected?(Required.)

Yes

No

*10.How long did you wait before someone assisted you?(Required.)

0-15 minutes

15-30 minutes

30-45 minutes

45+ minutes

*11.What type of assistance did you receive today?(Required.)

Weatherization

Power 

Rent/Shelter

Referral

Nutrition

Transportation

Propane

Water 

12.Overall, how would you rate the service you received from the staff at our office?

Excellent

Very good

Good

Fair

Poor