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* 1. What county do you live in?

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* 2. What SMCAA service/program did you receive during your visit?

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* 3. Please rank your level of satisfaction with your SMCAA visit.

  Strongly Agree Agree Disagree Strongly Disagree N/A
Staff was courteous and helpful.
Staff listened to my concerns.
Services were provided to me in a timely manner.
Staff explained what I needed to qualify for service.
Staff explained all paperwork to me and answered my questions.
Staff told me about other SMCAA programs that might be helpful to me.
Staff gave me information about other programs outside SMCAA that might be helpful to me, including how to contact those other programs.
My needs were met based on the services this program could provide me.
I would recommend this program if a friend was in need of similar help.
Overall, the quality of services I received was excellent.
Because of Community Action's help, I have improved my situation.

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* 4. Have you used SMCAA services/programs in the past?

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* 5. Would you be willing to participate in a discussion group to help SMCAA continue to improve?

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* 6. How did you hear about SMCAA?

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* 7. If you were referred from another agency, please specify:

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* 8. Please provide any comments or concerns you have regarding the services provided by SMCAA:

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* 9. If you would like us to follow up with you regarding your experience with SMCAA, please include your name and contact information.

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