Goodwill of Central and Coastal Virginia Referral Survey

WELCOME GOODWILL INDUSTIRES OF CENTRAL AND COASTAL VIRGINIA

Thank you for your time and effort to give us feedback about Goodwill's services. We are very interested in making sure we provide you with the best possible service. This survey should not take more than 2 minutes to complete and will help us better meet our referral parnters’ needs. Your answers will remain confidential. We appreciate your input!

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* 1. What is the primary reason you refer clients to Goodwill?

Cost effectiveness

Location

Reputation

Staff excellence

Services we provide

Other (please specify)

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* 2. How many referrals have you made in the last 12 months?

1 time

2-5

5-10

10-20

20+

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* 3. What service/program do you refer your clients most frequently or most recently?

Career Fair

Community Employment Center

Ability One - Job Placement

Ability One - Follow Along

Enclave - Job Placement

Enclave - Follow Along

Supported Employment - Job Placement

Supported Employment - Follow Along

TIE

Transitional Employment

Work Adjustment

Skills Building

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* 4. How do you feel about the services we provide regarding your referrals?

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The referral process is easy	The referral process is easy Strongly Agree	The referral process is easy Agree	The referral process is easy Neutral	The referral process is easy Disagree	The referral process is easy Strongly Disagree
Staff responsiveness	Staff responsiveness Strongly Agree	Staff responsiveness Agree	Staff responsiveness Neutral	Staff responsiveness Disagree	Staff responsiveness Strongly Disagree
Kept informed of client's progress	Kept informed of client's progress Strongly Agree	Kept informed of client's progress Agree	Kept informed of client's progress Neutral	Kept informed of client's progress Disagree	Kept informed of client's progress Strongly Disagree
The outcome obtained was desirable	The outcome obtained was desirable Strongly Agree	The outcome obtained was desirable Agree	The outcome obtained was desirable Neutral	The outcome obtained was desirable Disagree	The outcome obtained was desirable Strongly Disagree

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* 5. Rate your overall satisfaction with Goodwill

Very Satisfied

Satisfied

Undecided

Dissatisfied

Very Dissatisfied

No Answer

Very Satisfied

Satisfied

Undecided

Dissatisfied

Very Dissatisfied

No Answer

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* 6. Likelihood to use Goodwill in the future?

Very Likely

Likely

Undecided

Not Likely

Very Un-likely

No Response

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* 7. Likelihood to recommend Goodwill to others?

Very Likely

Likely

Undecided

Not Likely

Very Un-likely

No Response

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* 8. What could Goodwill do better?

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* 9. Please select type of Referring Agency. If Other, please describe.

State Vocational Rehabilitation Agency

Workforce Investment Act

School System

State Agency for the Blind

Veteran's Administration

Mental Health/Mental Retardation/Developmental Disabilities

Corrections/Justice System

Housing Authority and Agencies

TANF Administration

Other Public Health, Human & Social Service Agency

Private Rehabilitation Agency

Workers Compensation/Insurance Agency

Local Food Stamp Agency/WIC

Employer

Other private, Non-Profit Agency (other CBO/United Way/FBO)

Other (please specify)

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* 10. Please Enter the zip code for your organization:

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* 11. Contact Information (Name, Address, Phone Number & Email Address): Your contact information is optional.

Please contact us if you have concerns you would like to express or services we can provide.

Question Title

* 1. What is the primary reason you refer clients to Goodwill?

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* 2. How many referrals have you made in the last 12 months?

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* 3. What service/program do you refer your clients most frequently or most recently?

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* 4. How do you feel about the services we provide regarding your referrals?

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* 5. Rate your overall satisfaction with Goodwill

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* 6. Likelihood to use Goodwill in the future?

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* 7. Likelihood to recommend Goodwill to others?

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* 8. What could Goodwill do better?

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* 9. Please select type of Referring Agency. If Other, please describe.

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* 10. Please Enter the zip code for your organization:

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* 11. Contact Information (Name, Address, Phone Number & Email Address): Your contact information is optional.Please contact us if you have concerns you would like to express or services we can provide.

* 11. Contact Information (Name, Address, Phone Number & Email Address): Your contact information is optional.

Please contact us if you have concerns you would like to express or services we can provide.