Community Stakeholder Survey

We value your input and welcome your honesty in completing this community stakeholder survey. Please complete our survey by selecting an answer that best communicates your opinion. After completing the 10 questions, please provide additional comments and suggestions in the space provided.  Please indicate the number that represents your opinion using the following legend:

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* 1. When contacting us by phone, your call is answered promptly and courteously.

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* 2. Our staff returns phone calls and/or answer email messages in a timely manner.

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* 3. Requests for information are responded to in a timely manner.

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* 4. Our staff has treated you with respect each time you have had contact with our agency.

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* 5. Persons who request services and meet qualifications are admitted in a timely manner.

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* 6. Our agency treats all persons participating in our program with respect.

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* 7. Our staff is sensitive to differences in cultural backgrounds of the persons served.

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* 8. Our agency encourages and is open to feedback about the quality of our services.

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* 9. Our organization is highly respected in the community for providing quality services.

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* 10. Our program would be recommended to others without hesitation.

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* 11. Location

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* 12. Number of years you have known about our program:

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* 13. Are you employed by an organization that refers people to our program?

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* 14. Please select the focus that most applies to your organization:

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* 15. Your relationship with persons who have participated in our program:

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* 16. (Optional) Race:

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* 17. (Optional) Age:

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* 18. (Optional) Gender:

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* 19. Additional Comments or Suggestions:

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* 20. Date

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