FY2025 Client Satisfaction Survey Question Title * 1. Mark all services your household got from our agency within the last 12 months: LIHEAP/Heating Help Food Pantry WIC Head Start Early Head Start General Info/Referral Furnace Repair/Replace Clothing Assistance FaDSS (Family Development and Self Sufficiency) Housing Assistance Emergency Utility Preschool Scholarship Senior Home Repair Weatherization None Other (please specify) OK Question Title * 2. I got the information and services I needed: Yes No N/A Comments OK Question Title * 3. Additional program/service I would like Community Action to offer: OK Question Title * 4. I had a positive experience when receiving services: Yes No N/A (Does not apply) Comments OK Question Title * 5. I was informed about other agency or community services: YES NO N/A (Does not apply) OK Question Title * 6. Are there any problems or needs you or your family faced within the last 12 months you were unable to get help with? Yes (please list below) No If Yes please list those problems or needs OK Question Title * 7. What are the greatest challenges your household is currently facing? (Check all that apply) Employment Livable Wage Job Keeping a Job Getting food Food Budgeting Physical Health Mental Health Getting Medical Care Health Care Costs/Bills Budgeting Debt Payday Loans Housing Transportation Adult Education/Training Child Education Safety Legal Issues Abuse Substance Use Finding Childcare Paying for Child Care Child Care During Hours Needed Other (please specify) OK Question Title * 8. What is one suggestion you have for Community Action to improve on? OK Question Title * 9. How has Community Action made a difference in your life? OK Question Title * 10. Date Date / Time Date OK Question Title * 11. What county do you live in? Des Moines Henry Lee Louisa Muscatine Washington Other (please specify) OK Question Title * 12. Optional: Would you be willing to share your story? Yes No OK Question Title * 13. Optional: If you're willing to share your story, please provide your contact information. Name Email Address Phone Number OK Question Title * 14. Optional: Other Comments OK DONE