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* 1. What services brought you to the agency?

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* 2. Overall, how satisfied or dissatisfied are you with First State Community Action Agency?

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* 3. Which of the following words would you use to describe our services? (Check all that apply)

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* 4. How well do our services meet your needs?

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* 5. How would you rate the quality of our services?

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* 6. How responsive have we been to your questions or concerns about our services?

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* 7. How likely are you to request any of our services again?

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* 8. How important do the employees at First State Community Action Agency make you feel?

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* 9. How politely did our representative treat you?

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* 10. Do you have any other comments, questions, or concerns?

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* 11. Please provide your zip code:

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