Please complete the following survey regarding the services you received for CSEA Administrative Hearings Division (paternity/support/intake).

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* 1. Today's date:

Date

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* 2. Your age group:

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* 3. Race/Ethnicity:

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* 4. Gender:

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* 5. Which Service Area(s) did you most recently visit in person?

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* 6. Was the Reception staff helpful and professional?

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* 7. Which CSEA representative assisted you today? (optional)

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* 8. How long did you wait to be seen by a CSEA Representative today?

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* 9. Was the CSEA representative concerned with helping you?

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* 10. Did the CSEA Representative explain the actions being taken on your case?

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* 11. Do you feel your questions/concerns were adequately addressed and answered?

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* 12. Was the CSEA representative sensitive to your culture and treated you with respect?

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* 13. How was your overall experience with CSEA?

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* 14. Are you familiar with the CSEA website: www.mcsea.org ?

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* 15. If you are familiar with the CSEA Website, what do you use the website for?

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* 16. Are you aware that you can chat with a CSEA Specialist live and on-line at www.mcohio.org/childsupport ?

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* 17. Please provide additional comments, suggestions or positive experiences here:

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