Assistance Feedback Survey Listening to Hearts of Gold participants has always been important to us. We are especially interested in hearing feedback from participants who have applied for assistance. In an effort to ensure that we are best meeting the needs of our participants, please take a moment to let us know about your experience. All responses are anonymous. Question Title * 1. How long have you been contributing to Hearts of Gold? Less a year 1-5 years 5-10 years Since the beginning (2008) Question Title * 2. Was the application easy to understand and complete? If not, how could it be improved? Yes No If no, please explain: Question Title * 3. Was your application handled in a timely manner? If not, please explain what happened. Yes No If no, please explain: Question Title * 4. How satisfied are you with the outcome of your request? If not satisfied, please explain. Very satisfied Somewhat satisfied Not satisfied Please explain: Question Title * 5. How satisfied were you with the confidentiality of your application? If not satisfied, please explain. Very satisfied Somewhat satisfied Not satisfied Please explain: Question Title * 6. Would you encourage others to become a participant or utilize Hearts of Gold? If not, please tell us why Yes No If no, please explain: Question Title * 7. As a participant, how satisfied are you with Hearts of Gold? If not satisfied, please explain why. Very satisfied Somewhat satisfied Not satisfied Neutral/No opinion Please explain: Question Title * 8. Would you encourage others to become a participant or utilize Hearts of Gold? If not, please tell us why Yes No Please explain: Question Title * 9. Please let the Board know any other questions, comments, or concerns you may have regarding Hearts of Gold. Done