* 1. What type of service did you receive?

* 2. How were you referred to our agency?

* 3. How were you treated by staff

* 4. Was the service satisfactory? 

* 5. Did the service meet your need?

* 6. Did the service improve your family environment or nutritional needs?

* 7. How long have you known about Tri-County CAA services?

* 8. Did our services improve your education level?

* 9. Were you referred to: (Check as many as apply)

* 10. Are you current in an education program?

* 11. Do you volunteer for an agency or organization?

* 12. Are you employed?

* 13. Have you had an increase in salary in the last year?

* 14. Has your home been weatherized?

* 15. Has Tri-County CAA helped you to become self-sufficient?

* 16. What do you think Tri-County could do to improve their services?

* 17. Name and Date (optional)

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