Consumer Satisfaction Survey - Not Currently Working

Thank you for working with RSVP, Inc. Your satisfaction with our services is of the utmost importance. We welcome your feedback and suggestions.

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* 1. Please enter your name.

Name

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* 2. Please enter the RSVP, Inc. Specialist's Name

RSVP, Inc. Specialist's Name

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* 3. Please select the current service status:

Initial

Ongoing

Case Closure

Please select the most appropriate response to the following statements.

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* 4. I have input when making a job choice.

False

Somewhat False

Uncertain

Somewhat True

True

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* 5. I feel like I was helped to get ready to work in the community.

False

Somewhat False

Uncertain

Somewhat True

True

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* 6. I was asked to participate with my job search.

False

Somewhat False

Uncertain

Somewhat True

True

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* 7. I have learned new job skills.

False

Somewhat False

Uncertain

Somewhat True

True

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* 8. My job goal fits my interests.

False

Somewhat False

Uncertain

Somewhat True

True

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* 9. I have reliable transportation.

False

Somewhat False

Uncertain

Somewhat True

True

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* 10. I am treated with respect by RSVP, Inc. staff and employers.

False

Somewhat False

Uncertain

Somewhat True

True

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* 11. I feel safe in the community.

False

Somewhat False

Uncertain

Somewhat True

True

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* 12. I have identified a salary goal.

False

Somewhat False

Uncertain

Somewhat True

True

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* 13. I enjoy the job preparation/development process.

False

Somewhat False

Uncertain

Somewhat True

True

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* 14. I like working with RSVP, Inc. Specialists.

False

Somewhat False

Uncertain

Somewhat True

True

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* 15. I receive SSI/SSDI disability benefits.

Yes

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* 16. I am able to maintain my SSI/SSDI disability benefits?

Yes

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* 17. I receive Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Yes

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* 18. I am able to maintain my Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

Yes

Consumer Satisfaction Survey - Not Currently Working

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* 1. Please enter your name.

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* 2. Please enter the RSVP, Inc. Specialist's Name

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* 3. Please select the current service status:

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* 4. I have input when making a job choice.

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* 5. I feel like I was helped to get ready to work in the community.

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* 6. I was asked to participate with my job search.

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* 7. I have learned new job skills.

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* 8. My job goal fits my interests.

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* 9. I have reliable transportation.

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* 10. I am treated with respect by RSVP, Inc. staff and employers.

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* 11. I feel safe in the community.

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* 12. I have identified a salary goal.

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* 13. I enjoy the job preparation/development process.

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* 14. I like working with RSVP, Inc. Specialists.

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* 15. I receive SSI/SSDI disability benefits.

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* 16. I am able to maintain my SSI/SSDI disability benefits?

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* 17. I receive Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

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* 18. I am able to maintain my Medicaid (SSI), Medicare (SSDI), or other Health Benefits?

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* 19. I have out-of-pocket disability-related work expenses (i.e., transportation, medications, supplies, etc.)

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* 20. Things I like about my services/outcome:

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* 21. Things I do not like about my services/outcome:

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* 22. Date Survey Completed