Exit Participant Satisfaction Survey We'd like to deliver the highest quality service possible and to make that happen we would like to hear from you! You do not have to answer all questions, skip the ones you don't want. Question Title * 1. Do you currently receive support from Nanaimo Supportive Lifestyles? Yes, individual support Yes, group support Yes, both group and individual support No Question Title * 2. What is your age? Question Title * 3. Are you a member of the LGBTQ2S+ Community? yes no prefer not to answer Question Title * 4. Which race/ethnicity best describes you? (Please choose only one.) First Nations or Indigenous Asian Black or African American Hispanic White / Caucasian Multiple ethnicity / Other (please specify) Question Title * 5. In what language do you read most fluently? English French ASL (sign language) Other (please specify) Question Title * 6. Do you identify with any of the following religions? (Please select all that apply.) Protestantism Catholicism Christianity Judaism Islam Buddhism Hinduism Inter/Non-denominational No religion Other (please specify) Question Title * 7. Which of the following options most closely aligns with your gender? Woman Man Non-binary A gender not listed here Transgender Prefer not to answer Question Title * 8. Overall, how would you rate the quality of your services? Very positive Somewhat positive Neutral Somewhat negative Very negative Question Title * 9. How friendly are the support staff? Extremely friendly Very friendly Somewhat friendly Not so friendly Not at all friendly Question Title * 10. How well do you feel Nanaimo Supportive Lifestyles protects your privacy? Extremely well Very well Somewhat well Not so well Not at all well Question Title * 11. How convenient is our location for you? Extremely convenient Very convenient Somewhat convenient Not so convenient Not at all convenient Question Title * 12. Does your support worker provide you with the help you need? Yes No Sometimes Question Title * 13. Do you access any of our additional services? (check all that apply) Board Game Group Hiking Group AA Meetings LGBTQ Peer Group Self Advocacy Group None of those Question Title * 14. Are there support services missing in our community you wish were available? Yes No If you said "yes" please let us know. Question Title * 15. Do your support services happen at a time/place that is convenient for you? Yes No If "no" please let us know how we could improve Question Title * 16. Anything else you would like to share about the services your receive at Nanaimo Supportive Lifestyles? Question Title * 17. Is our use of technology beneficial for you in the form(s) of computers, tablets, aids etc.? Yes No (please let us know how we can do better) Question Title * 18. Do you have any barriers to receiving service? (check any that apply) Financial (can't afford activities) Transportation (can't get to services) Physical (barriers to facility, entrance, etc) Psychological (feel unsafe in space, with supports) Other (please specify) None of the above Done
