Your comments are important to us. Please take a moment to fill out this survey.

Please help us make services better by answering some questions about the services that you, your family member or ward have received from us OVER THE LAST 12 MONTHS. Your answers are anonymous and confidential and will not influence the services that you, your family member or ward continues to receive.

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* 1. Date

Date

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* 2. I'm in:

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* 3. Please answer some questions about the services that you have received

  Strongly Agree Agree Undecided Disagree Strongly Disagree N/A
1. I like the services that I receive.
2. I had the information I needed to make choices about services I receive.
3. I had the information I needed to make choices about my goals.
4. The staff stuck with me no matter what.
5. I could talk to a staff person when I needed to.
6. Staff encouraged me to participate in activities.
7. The services were the ones I needed.
8. The location of services was convenient (i.e., parking, distance, public transportation).
9. Services were at convenient times.
10. Staff has been respectful to me.
11. I can understand things that Staff has explained to me.
12. I am comfortable asking staff questions.
13. Staff have told me about recipient rights.
14. I feel free to complain if I didn’t like something about my services.
15. Staff are sensitive to my cultural background (i.e., food, language, religion).
16. I am satisfied with my current living situation.
17. I like my current school, work setting and/or activity program.
18. If I had other choices, I would still get services from Goodwill.
19. I would recommend Goodwill to a friend or family member.
20. I’m making progress is towards achieving my goals because of these services.

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* 4. What would improve the services here?

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* 5. What has been the most helpful thing about the services you/your family member/your ward received over the last 12 months?

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