My Age:

Question Title

* 1. My Age:

I am a:

Question Title

* 2. I am a:

My race/ethnicity is:

Question Title

* 3. My race/ethnicity is:

Indicate the category which best describes you:

Question Title

* 4. Indicate the category which best describes you:

Number of years interacting with this agency:

Question Title

* 5. Number of years interacting with this agency:

Times in contact with this agency in the last 12 months:

Question Title

* 6. Times in contact with this agency in the last 12 months:

The facility was clean, orderly and accessible.

Question Title

* 7. The facility was clean, orderly and accessible.

Staff members were knowledgeable, helpful and readily identified themselves.

Question Title

* 8. Staff members were knowledgeable, helpful and readily identified themselves.

The web site was easy to use and well organized.

Question Title

* 9. The web site was easy to use and well organized.

The web site contained clear and accurate information on events, services and contact information.

Question Title

* 10. The web site contained clear and accurate information on events, services and contact information.

My telephone call, e-mail or letter inquiry was routed to the proper person.

Question Title

* 11. My telephone call, e-mail or letter inquiry was routed to the proper person.

My telephone call, letter or e-mail inquiry was answered in a reasonable amount of time.

Question Title

* 12. My telephone call, letter or e-mail inquiry was answered in a reasonable amount of time.

Printed brochures or written material provided thorough and accurate information.

Question Title

* 13. Printed brochures or written material provided thorough and accurate information.

My inquiry to the agency was addressed in a reasonable manner.

Question Title

* 14. My inquiry to the agency was addressed in a reasonable manner.

This organization makes it easy to give suggestions or to make a complaint.

Question Title

* 15. This organization makes it easy to give suggestions or to make a complaint.

Overall, I am satisfied with my experience.

Question Title

* 16. Overall, I am satisfied with my experience.

Help Us Serve You Better: Please provide additional comments on staff performance, agency services, and/or suggested improvements.

Question Title

* 17. Help Us Serve You Better: Please provide additional comments on staff performance, agency services, and/or suggested improvements.

T