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Client Services Survey April 2020
The purpose of this survey is to establish a baseline for needs in our community so we can better inform you of available services and supplies as they become available.
OK
1.
Name of Organization
2.
Contact Name
3.
Contact number
4.
What level of need are you seeing in the community for the following:
No need
Some need
Lots of need
Client support for rent
No need
Some need
Lots of need
Client support for water bills
No need
Some need
Lots of need
Client support for gas
No need
Some need
Lots of need
Client support for prescriptions
No need
Some need
Lots of need
Client support for internet
No need
Some need
Lots of need
Client support for phone bills
No need
Some need
Lots of need
Client support for child care assistance
No need
Some need
Lots of need
5.
What level of need are you seeing in the community for the following requests from clients:
No need
Some need
Lots of need
Hand Sanitizer
No need
Some need
Lots of need
Masks
No need
Some need
Lots of need
Diapers
No need
Some need
Lots of need
Baby wipes
No need
Some need
Lots of need
Baby formula
No need
Some need
Lots of need
Food
No need
Some need
Lots of need
Laundry soap
No need
Some need
Lots of need
Body soap/shampoo/deodorant/hand soap
No need
Some need
Lots of need
Paper products - paper towels/toilet paper
No need
Some need
Lots of need
Cleaning supplies
No need
Some need
Lots of need
6.
Is your organization supplying clients with any of the items above?
Yes
No
7.
If yes, what items?
Hand Sanitizer
Wipes
Diapers
Baby Wipes
Baby Formula
Food
Laundry Soap
Body soap/Shampoo/ deodorant/hand soap
Paper products: paper towels/toilet paper
Cleaning supplies
8.
Please briefly explain the services your organization is providing to clients.
9.
In what counties does your organization provide services? (check all that apply)
Cerro Gordo
Worth
Hancock
Winnebago
Butler
Mitchell
Floyd
Franklin
Kossuth
Current Progress,
0 of 9 answered