Customer Satisfaction Survey
Name Date:
Address  
Phone Number        

eMail Address

        

Please answer a couple of questions so that we can better serve you.
     
Did you have any trouble finding our office? Yes No  
Were you treated courteously?  Yes No  
If no, please explain:       
Were you seen timely? Yes No  
Was your application processed timely? Yes No
  
Did you feel that our staff explained your rights and responsibilities clearly? Yes No  
Were you provided a Change Report Form to report form to report changes? Yes No  
Are you looking for a job, or a better job? Yes No  
      If yes, were you told about our Seneca One Stop employment resource center? Yes No  
If our agency was not able to provide you assistance,
were you referred to a partner agency or other organization? 		Yes No  
Which departments have you worked with?
To select more than one department , press Ctrl while selecting
  		     
Are you currently receiving assistance of any kind?    Yes No  
  
If yes, what assistance are you receiving?
   
    ADC/OWF
 
Child Care
 
Child Support
 
Disability Assistance
 
Food Stamps
 
Medicaid
 
Healthy Start
 
WIA Services
  Where did you hear about our services?    
  Newspaper
Which newspaper?
  Radio Which radio station?
  Other Where/Who? 
Other Comments:
Do you have any suggestions on how we can provide better customer service?:  
Would you like to be contacted regarding this survey?   Yes No  
   
   
   

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