Head Start Application Satisfaction Survey

Question Title

1. Date of Application Interview:

Ex: MM/DD/YYYY

Date

Question Title

2. Location of Application Interview:

Question Title

3. Person who assisted me with the Interview:

Question Title

4. Overall, how satisfied or dissatisfied were you with your experience?

If Dissatisfied, please let us know why:

Question Title

5. How responsive was staff to your questions and/or your concerns?

If Not Responsive, please let us know why:

Question Title

6. Was NHA Staff professional and courteous?

Yes

If No, please explain:

Question Title

7. Was everything clearly explained?

Yes

If No, please explain:

Question Title

8. We would appreciate your suggestions for improvement and/or any comments, questions or concerns.

Question Title

9. Would you like to receive a telephone call from NHA management to further discuss your Application experience? If YES, please share your name, the best telephone number and time of day to call.

My Name:

Phone #:

Best Time:

Question Title

* 1. Date of Application Interview:

Question Title

* 2. Location of Application Interview:

Question Title

* 3. Person who assisted me with the Interview:

Question Title

* 4. Overall, how satisfied or dissatisfied were you with your experience?

Question Title

* 5. How responsive was staff to your questions and/or your concerns?

Question Title

* 6. Was NHA Staff professional and courteous?

Question Title

* 7. Was everything clearly explained?

Question Title

* 8. We would appreciate your suggestions for improvement and/or any comments, questions or concerns.

Question Title

* 9. Would you like to receive a telephone call from NHA management to further discuss your Application experience? If YES, please share your name, the best telephone number and time of day to call.

1. Date of Application Interview:

2. Location of Application Interview:

3. Person who assisted me with the Interview:

4. Overall, how satisfied or dissatisfied were you with your experience?

5. How responsive was staff to your questions and/or your concerns?

6. Was NHA Staff professional and courteous?

7. Was everything clearly explained?

8. We would appreciate your suggestions for improvement and/or any comments, questions or concerns.

9. Would you like to receive a telephone call from NHA management to further discuss your Application experience? If YES, please share your name, the best telephone number and time of day to call.