Client Customer Satisfaction & Information Survey Question Title * 1. I was helped in a timely manner. Yes No None of the above Question Title * 2. I was treated with respect. Yes No None of the above Question Title * 3. The staff were friendly and helpful. Yes No None of the above Question Title * 4. I got the information and/or services I needed. Yes No None of the above Question Title * 5. I was informed about other agency or community services. Yes No None of the above Question Title * 6. I would recommend your agency to family and friends. Yes No None of the above Question Title * 7. What is ONE thing you would change about the services you received from our agency? Question Title * 8. How did you learn about our agency? Select all that apply: Family or Friend Current or former agency client United Way 211 Radio Healthcare provider Social media (Facebook, Instagram, etc.) Local Church Television A state agency Other social service agency Brochure or Flyer A Mailing Websites/Internet Newspaper Phone Book Billboard The household I grew up in had received agency services. Other (please specify) Question Title * 9. What services has your household received from our agency within the last 12 months? Select all that apply: Energy Assistance (LIHEAP or PIPP) Weatherization Neighbor to Neighbor Head Start/Early Head Start Golden Meals Rent or Water Assistance Scholarship HOME/HRAP Benefit Access Question Title * 10. What kind of issues in your family or neighborhood are a concern to you? Question Title * 11. If given the opportunity, would you be willing to serve on a local board or committee that represents and makes decisions for families with low incomes? Yes No If yes, please provide your name, phone number and email: Done