Appendix A 5_Example Client Survey

OMB # 0970-XXXX

Expiration Date: XX/XX/XXXX

Appendix A.5:

Survey Questions for Clients

DRAFT Survey Questions

Overall, how satisfied are you with the services you received from [PROGRAM/AGENCY]?

1. Very satisfied

2. Somewhat satisfied

3. Neutral

4. Not very satisfied

5. Not at all satisfied

How much effort did it take to get the services you needed?

1. Very Difficult

2. Difficult

3. Neutral

4. Easy

5. Very Easy

How often did you interact with the staff?

1. Every day or almost every day

2. 3 or 4 times per week

3. 1 or 2 times per week

4. 2 or 3 times in the past month

5. Once in the past month

6. Less than once a month

7. Not at all

Overall, how would you rate your interactions with the staff?

1. Excellent

2. Good

3. Average

4. Fair

5. Poor

6. Don’t know/not applicable

What types of services and help did you receive?

	Yes	No	DK
Help with resume writing?
Assistance with identifying potential employers?
Assistance with completing job applications?
Help with job interviewing skills?
Help arranging child care
Transportation assistance
Help with work-appropriate clothing
General money management assistance

Overall, how would you rate the quality of the services and help?

1. Very high

2. High

3. Neither high nor low

4. Low

5. Very low

How well did the services meet your needs?

1. Extremely well

2. Very well

3. Somewhat well

4. Not so well

5. Not well at all

How much have these services helped you in the following areas?

	Not at all	A little	A fair amount	A lot
Resume writing
Identifying potential employers
Completing job applications
Interviewing skills
Arranging child care
Transportation assistance
Choosing work-appropriate clothing
General money management