Client Satisfaction Survey
Exit Survey
Questions marked with a
*
are required
100%
Did
SELF HELP INC.
help you or anyone in your household in the past 12 months?
Yes
No
Which
SELF HELP INC.
services have you used in the past 12 months?
Check all that apply
Fuel assistance (LIHEAP)
Head Start
Attleboro Food Bank
Weatherization Assistance Program (WAP)
Heating Emergency Assistance Retrofit Task Weatherization Assistance Program (HEARTWAP)
Appliance Management Program (AMP)
Coordinated Family and Community Engagement
Community Outreach- (Information and Referral Services)
Brockton Lead Abatement Program
VITA-Tax Assistance Program
Hand-In-Hand Elder Case Management
Parent Child+ Home Visiting
SNAP Application Assistance
COVID Safe Cooling (AC Distribution)
EARLY HEAD START
Other
N/A
How did you learn about
SELF HELP INC
?
Another person told me about it
Staff at another agency or organization referred me
I found Self Help Inc’s website
I saw a flyer or poster
I heard about it on TV or radio
On Social Media (Facebook/Twitter)
Other
Please Tell Us a Little Bit About Your Experience with Self Help Inc. and our Staff
I feel welcome at the
SELF HELP INC.
office or when I talk with staff on the phone.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
SELF HELP INC.
staff understand my needs and culture.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
SELF HELP INC.
staff treat me with respect and do not judge me.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
SELF HELP INC.
staff support me to make my own decisions
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
I am satisfied with how
SELF HELP INC.
staff have treated me.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
My situation is better because of the help
SELF HELP INC.
gave me.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
My finances are more stable because of help from
SELF HELP INC
.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
I can take care of my family or myself better because of the assistance I received from
SELF HELP INC
.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
SELF HELP INC.
helped me learn about helpful resources near where I live.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
I am satisfied with the help I got from
SELF HELP INC
.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
No opinion
Did anything make it hard for you to get assistance from
SELF HELP INC.
?
Hours
Parking
Transportation
Child care
Disability
I felt embarrassed
I felt overwhelmed
Immigration or citizenship status
I couldn't understand what the staff person was saying
Information was too hard to read
Too much paperwork
Tired of answering the same questions over and over again
Other
N/A
How could
SELF HELP INC
. improve? Please give us your suggestions:
What other assistance and/or programs would you like
SELF HELP INC
. to offer in the future?
In general, do you feel that you are………
Better off than you were 1 year ago
Worse off than 1 year ago
About the same as you were 1 year ago
Other
Where do you live?
Abington
Attleboro
Avon
Bridgewater
Brockton
Canton
Dedham
East Bridgewater
Easton
Foxboro
Franklin
Hanson
Holbrook
Mansfield
Middleboro
Needham
Norfolk
North Attleboro
Norton
Norwood
Plainville
Randolph
Raynham
Rockland
Sharon
Stoughton
Walpole
West Bridgewater
Westwood
Whitman
Wrentham
Other
What is your Zip Code?
Can
SELF HELP INC
. use your comments and testimonial on our website or in our future marketing efforts?
YES!
No
If you would like someone to reach out to in regard to your responses, please provide your contact info. below
First Name
Last Name
Phone
Email Address
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