The reason for this survey is to compile information regarding Families First Support Services (F.F.S.S.) past and present services.  This survey is open to all Listuguj residents who have accessed our services as well as their significant others.  We are a voluntary prevention-based program, striving to meet the needs of ALL our community members.

All responses are CONFIDENTIAL and will only be used by Families First to evaluate and forecast future programming.

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* 1. What is your gender?

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* 2. What is your age bracket?

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* 3. What is your marital status?

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* 4. Residency

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* 5. What is your financial situation?

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* 6. Number of adults within the home

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* 7. How many children in the home?

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* 8. How did you hear about Families First Support Services?

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* 9. Do you know of these services provided by F.F.S.S.?

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* 10. Have you ever accesses services from F.F.S.S.?

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* 11. If yes, what services?

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* 12. How often did you access services?

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* 13. How was the intake process? (Check all that apply)

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* 14. Have you attended a F.F.S.S. event? (Check all that apply)

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* 15. Do you have any suggestions for improvement regarding our services? Please explain.

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* 16. If we gave you a "Magic Wand" to change anything in our community, what would be your suggestion(s)?

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* 17. Have you attended a F.F.S.S. event? (Check all that apply)

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* 18. Do you think our programming/events are well known and advertised?

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* 19. Have you ever accessed services at F.F.S.S. by referral through another resource?

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* 20. If yes, who referred you to F.F.S.S.?

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* 21. What does a Home Support Worker do? (Check all that apply)

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* 22. What does a Clinical Supervisor do? (Check all that apply)

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* 23. What does an Intake Worker do? (Check all that apply)

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* 24. What does the Cultural Male Mentor do? (Check all that apply)

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* 25. In your opinion, which of these statements apply to F.F.S.S.?

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* 26. What are your thoughts on Spirituality?

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* 27. In your opinion, is F.F.S.S. meeting the needs of the community regarding spirituality and cultural activities?

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* 28. Do you practice Spirituality?

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* 29. Thank you for participating in our survey! If you would like a chance to win a prize, please enter your name and contact information here.

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