Customer Satisfaction Survey Question Title * 1. How did you hear about us? Family/ Friend United Way 211 Local Church Newspaper Internet/Website/Social Media Social Service Agency Township Trustee Other (please specify) OK Question Title * 2. Is this your first time using or applying for SCCAP services? Yes No Not Applicable OK Question Title * 3. What county do you live in? Monroe Owen Morgan Brown OK Question Title * 4. What brought you to SCCAP? Apply for help with utility bills Sign up for Head Start/ Early Head Start Assistance applying for health insurance (Covering Kids and Families) Housing Appointment (Housing Choice Voucher) Apply for (or follow up on) weatherization on home Other (please specify) OK Question Title * 5. Was the office easy to find, well-marked, and convenient? Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree OK Question Title * 6. Were staff friendly and helpful? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 7. Were you served in a timely manner? Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree OK Question Title * 8. Was your need or reason for coming to SCCAP taken care of? Yes No - I did not qualify No - I need to provide additional documentation No - SCCAP does not offer the service I need Not applicable OK Question Title * 9. Since participating in SCCAP services, do you feel you are: More self-supporting Less self-supporting No change Prefer not to answer Not applicable OK Question Title * 10. Did staff offer information about other services provided by SCCAP? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 11. If SCCAP could not meet your need(s), were you referred to other providers? Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 12. What barriers did you have when accessing services? No barriers Disabled/physical limitations Language/interpreter needed Transportation Issues (Please specify issue. No car, no gas, no bus ticket, unable to find a ride, etc.) OK Question Title * 13. Please check which SCCAP services you have used in the last 12 months. Housing Choice Voucher (Section 8) Weatherization Assistance Program Covering Kids and Families (assistance applying for health insurance) Affordable Housing Head Start/ Early Head Start Energy Assistance Program Growing Opportunities Thriving Connections None of the Above OK Question Title * 14. Which SCCAP services would you like more information about? Housing Choice Voucher Weatherization Assistance Program Covering Kids and Families Affordable Housing Head Start/ Early Head Start Energy Assistance Program Growing Opportutnies Thriving Connections None of the Above OK Question Title * 15. Overall, how do you rate the quality of services we provide? Very Good Good Fair Poor Very Poor OK Question Title * 16. Please provide any other feedback you have for our agency: OK Question Title * 17. If you are interested in sharing your story with us, please provide your contact details below (optional): Name Address Email Address Phone Number OK DONE