CUSTOMER FEEDBACK SURVEY

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* 3. Overall, how would you rate the quality of services received as part of this program?

Excellent

Good

Fair

Poor

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* 4. To what extent have the services provided through this program met your needs?

Almost all of my needs have been met.

Most of my needs have been met.

Only a few of my needs have been met.

None of my needs have been met.

If you have needs that are not being met, please describe them here:

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* 5. Did staff members offer you additional information about other programs that might help you and your family?

Yes

Not sure

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* 6. How would you rate staff members’ knowledge of BVCA Partnership’s programs and services?

Excellent

Good

Fair

Poor

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* 7. Please mark your level of agreement or disagreement with the following statements:

	Strongly agree	Agree somewhat	Neither Agree or Disagree	Disagree somewhat	Strongly disagree
Staff members treat me with respect.	Staff members treat me with respect. Strongly agree	Staff members treat me with respect. Agree somewhat	Staff members treat me with respect. Neither Agree or Disagree	Staff members treat me with respect. Disagree somewhat	Staff members treat me with respect. Strongly disagree
I feel welcome when I visit the facility.	I feel welcome when I visit the facility. Strongly agree	I feel welcome when I visit the facility. Agree somewhat	I feel welcome when I visit the facility. Neither Agree or Disagree	I feel welcome when I visit the facility. Disagree somewhat	I feel welcome when I visit the facility. Strongly disagree
The facility is clean and comfortable.	The facility is clean and comfortable. Strongly agree	The facility is clean and comfortable. Agree somewhat	The facility is clean and comfortable. Neither Agree or Disagree	The facility is clean and comfortable. Disagree somewhat	The facility is clean and comfortable. Strongly disagree
Because of BVCA Partnership’s help, I have improved my situation.	Because of BVCA Partnership’s help, I have improved my situation. Strongly agree	Because of BVCA Partnership’s help, I have improved my situation. Agree somewhat	Because of BVCA Partnership’s help, I have improved my situation. Neither Agree or Disagree	Because of BVCA Partnership’s help, I have improved my situation. Disagree somewhat	Because of BVCA Partnership’s help, I have improved my situation. Strongly disagree

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* 8. Would you recommend this program or service to others?

Definitely yes

Probably yes

Probably no

Definitely no

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* 9. How did you hear about this program or service? (Select all that apply.)

Family or friends

Internet

Referral from program not part of BVCA Partnership

Referral from another BVCA Partnership program

Not sure

Other (please specify)

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* 10. What does your family struggle with the most?

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* 11. What is the primary language spoken in your home?

English

Spanish

Another language (please specify):

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* 12. What is your age?

18-23

24-34

35-44

45-54

55-64

65-74

75 or older

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* 13. What is your gender?

Male

Female

Not Listed (please specify):

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* 14. Are you Hispanic or Latino?

Yes

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* 15. What is your race?

African American

Asian or Pacific Island

White

Native American

Bi-Racial

Multi-Racial

Other (please specify):

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* 16. If you have anything else you want us to know, please use the space below.

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* 17. If you wish to be contacted by one of BVCA's coordinators, please provide your name & contact information below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

CUSTOMER FEEDBACK SURVEY | FY'25

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* 1. Program or Service:

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* 2. County

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* 3. Overall, how would you rate the quality of services received as part of this program?

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* 4. To what extent have the services provided through this program met your needs?

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* 5. Did staff members offer you additional information about other programs that might help you and your family?

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* 6. How would you rate staff members’ knowledge of BVCA Partnership’s programs and services?

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* 7. Please mark your level of agreement or disagreement with the following statements:

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* 8. Would you recommend this program or service to others?

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* 9. How did you hear about this program or service? (Select all that apply.)

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* 10. What does your family struggle with the most?

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* 11. What is the primary language spoken in your home?

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* 12. What is your age?

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* 13. What is your gender?

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* 14. Are you Hispanic or Latino?

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* 15. What is your race?

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* 16. If you have anything else you want us to know, please use the space below.

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* 17. If you wish to be contacted by one of BVCA's coordinators, please provide your name & contact information below.