Customer Feedback Survey

1.Which program or programs have you participated in?  Please    check all that apply.
2.How was the enrollment or application process?
3.Agency staff treated me with respect and was sensitive to my
situation and needs.
4.Agency was able to meet my needs.
5.Agency staff were not able to meet my needs but I was referred to other resources.
6.How did you hear about us?
7.Do you have any additional comments?
8.Name (optional)
9.Would you like to be contacted?
10.Contact information (phone number, email, etc.)