EmailMeForm
SCAC Customer Satisfaction Survey
Today's Date
MM
/
DD
/
YYYY
Gender
Please select
Male
Female
Age
Please select
0-5
6-11
12-17
18-23
24-44
45-54
55-69
70+
Ethnicity
Please select
Hispanic, Latino or Spanish Origin
Non Hispanic, Latino or Spanish Orgin
Race
Please select
White
Black or African American
American Indian/Alaska Native
Asian
Native Hawaiian/Other Pacific Islander
Multi-race (any 2 or more of the above)
Number in household?
Number of children under 18
Education Level
Please select
0-8
9-12/Non-Graduate
High School Graduate/GED
12+ Some Post Secondary
2 or 4 yr College Graduate
Do you have health insurance?
Please select
Yes
No
Family Type
Please select
Single Parent Female
Single Parent Male
Two Parent Household
Single Person
Multiple Adults, No Children
Housing
Please select
Own
Rent
Homeless
Other
If you answered "Other" to Housing, please explain.
How did you learn about Southwestern Community Action Council, Inc.?
Please select
Advertisement
Family/Friend
Flyer/Brochure
Referral from community based organization
Social Media
What services did we provide?
Please select
Early Head Start
Free Income Tax Assistance
Head Start
In Home Services
Mason County Homeless Shelter
Senior Employment Services
Supportive Services for Veterans Families
Utility Assistance
Weatherization
Describe how satisfied you are with the services you received from our agency by checking the rating which best describes your experience.
Strongly Agree
Agree
Neutral or Not Applicable
Disagree
Strongly Disagree
Did staff assist you in a timely manner?
Staff were courteous, respectful, friendly and helpful.
Staff listened and responded to my concerns.
If applicable, staff completed a thorough assessment of all my needs, not just those for which I was initially seeking assistance.
Staff explained all paperwork to me and answered my questions.
Did staff do what they said they would do?
If staff were unable to meet my needs, the reasons were clearly explained to me.
My overall service experience was positive.
Do you have any recommendations to improve how we serve you?
If you would like to take a service-specific survey please select the program below and click Next Page to continue. If you wish to complete this survey now please select "Complete Survey, I do not wish to continue" and click Next Page to complete the survey. Thank you.
Complete Survey, I do not wish to continue
Early Head Start
Free Income Tax Assistance
Head Start
In Home Services
Mason County Homeless Shelter
Senior Employment Services
Supportive Services for Veterans Families
Utility Assistance
Weatherization