Evaluating Programs and Services Long-Term Case Managment 

We seek your feedback to help Yellowstone Country Assistance Network improve our services. We are conducting a community needs assessment, and your response is vital to help us plan for future services. We are enclosing a self-addressed stamped envelope to return the survey and a gift card to buy coffee on us! Thank you for your participation. 
Customer Demographic Information

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* 1. What county do you reside in?

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* 2. What is your gender?

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* 3. Which race/ethnicity best describes you? (Please choose only one.)

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* 4. What is your age?

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* 5. What is your approximate average household income?

Tell us about the community partner that referred you to YCAN

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* 6. What community partner organization referred you to YCAN for financial assistance?

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* 7. What led you to work with your case manager at the organization mentioned above?

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* 8. How friendly was the staff at the organization mentioned above?

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* 9. How likely is it that you would recommend organization listed above to a friend or colleague?

Not at all likely
Extremely likely
Tell us about your experience with Yellowstone Country Assistance Network 

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* 10. How convenient was the application process?

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* 11. Once your case manager submitted your application to Yellowstone Country Assistance Network, how responsive was the staff to your needs?

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* 12. What type of services did Yellowstone Country Assistance Network provide you besides an eligibility determination? (check all that apply)

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* 13. How well did Yellowstone Country Assistance Network meet your expectations in providing an eligibility determination and financial assistance?

Tell us about your overall experience. 

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* 14. Overall, how would you rate the quality of your customer service experience with your case manager and YCAN's partnership?

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* 15. What changes would YCAN have to make for you to give it a higher rating?

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* 16. What services did you need that were not available in your community?

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* 17. Would you be interested in participating in a focus group to discuss improving YCAN services further?

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* 18. If you want to be included in a focus group, please add your contact information below; each participant will receive a gift card for participation.

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