Energy Assistance Survey

Your feedback is important to us. We want to know what you think the program does well, and identify where we can improve. Your responses will be anonymous. Thank you for your help to increase the quality of our program services.

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* 1. Tell us about your experience.

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not applicable
Staff was respectful, courteous, and professional.	Staff was respectful, courteous, and professional. Strongly Agree	Staff was respectful, courteous, and professional. Agree	Staff was respectful, courteous, and professional. Disagree	Staff was respectful, courteous, and professional. Strongly Disagree	Staff was respectful, courteous, and professional. Not applicable
Staff took the time to answer my questions and provided clear information.	Staff took the time to answer my questions and provided clear information. Strongly Agree	Staff took the time to answer my questions and provided clear information. Agree	Staff took the time to answer my questions and provided clear information. Disagree	Staff took the time to answer my questions and provided clear information. Strongly Disagree	Staff took the time to answer my questions and provided clear information. Not applicable
Staff was knowledgeable about services.	Staff was knowledgeable about services. Strongly Agree	Staff was knowledgeable about services. Agree	Staff was knowledgeable about services. Disagree	Staff was knowledgeable about services. Strongly Disagree	Staff was knowledgeable about services. Not applicable
Staff followed through with commitments.	Staff followed through with commitments. Strongly Agree	Staff followed through with commitments. Agree	Staff followed through with commitments. Disagree	Staff followed through with commitments. Strongly Disagree	Staff followed through with commitments. Not applicable
Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me.	Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me. Strongly Agree	Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me. Agree	Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me. Disagree	Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me. Strongly Disagree	Staff told me about other NeighborImpact programs and/or services that may be available/helpful to me. Not applicable

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* 2. What was the result of your visit with NeighborImpact?
(Please check all that apply.)

I received the service I was seeking.

My application for services is pending.

I did not receive the service I was seeking.

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* 3. Would you recommend Energy Assistance to others?

Yes

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* 4. What county or community do you reside in?

Crook County

Deschutes County

Jefferson County

Confederated Tribes of Warm Springs

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* 5. Please indicate your ethnicity:

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* 6. Please indicate your race:

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* 7. How did you hear about NeighborImpact?

Local Radio Station

Local Television Station

Local Newspaper·

Social media: Facebook, Instagram, Twitter

Email Newsletter

Website or Search Engine

NeighborImpact Website

Other Agency Referral

Recommendation from friend or family member

Other (please specify)

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* 1. Tell us about your experience.

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* 2. What was the result of your visit with NeighborImpact?(Please check all that apply.)

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* 3. Would you recommend Energy Assistance to others?

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* 4. What county or community do you reside in?

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* 5. Please indicate your ethnicity:

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* 6. Please indicate your race:

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* 7. How did you hear about NeighborImpact?

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* 8. Additional Comments

* 2. What was the result of your visit with NeighborImpact?
(Please check all that apply.)