COUNCIL OF THE SOUTHERN MOUNTAINS
CONSUMER SATISFACTION SURVEY
Name(Optional):__________________________________Date:___________________________________
The Council exists to help our neighbors improve their lives through quality services, competent staff and innovative community interventions. One way to ensure we meet our goals and agency mission is to document what our consumers think about our services.
Please complete the following survey so the Council can identify how we are performing of duties. Thank you for your assistance and remember the Council wants to “Bring Opportunities Within Reach” for you. By completing this survey, you can help us improve.
Please circle the service you received:
1. Food Pantry/Emergency Food 5. Mentoring Children of Promise
2. Family Day Care Food Program 6. Foster Grandparent Program
3. V.I.T.A (Volunteer Income Tax 7. Retired Senior and Volunteer
Assistance Program) Program
4. Weatherization 8. Other(please name):_________
Gender: Male Female Age: 18-24 25-34 35-49 50-65 Over 65
Please read the following statements and circle one number below which best describes your experience with the Council of the Southern Mountains. Remember 1 is Excellent and 5 is Poor.
1. Strongly Agree With Statement- SA
2. I Agree With the Statement-A
3. I Am Neutral-N
4. I Disagree With the Statement-D
5. I Strongly Disagree with the Statement-SD
6. Statement Does Not Apply-NA
Statement-Circle Number That Applies At the Right SA A N D SD NA
1 2 3 4 5 6
1. I was treated with kindness and respect when I first came to the agency. 1 2 3 4 5 6
2. The staff were willing to help me. 1 2 3 4 5 6
3. Staff referred me to another agency if the Council could not help my request. 1 2 3 4 5 6
4. I was waited on promptly and did not have to wait too long. 1 2 3 4 5 6
5. My privacy was honored. 1 2 3 4 5 6
6. The services or assistance I received met my needs. 1 2 3 4 5 6
7. The agency or services are conveniently located. 1 2 3 4 5 6
8. The web site is easy to navigate and informative. 1 2 3 4 5 6
9. I would recommend the agency to others. 1 2 3 4 5 6
10. Overall, I am satisfied with the services I received. 1 2 3 4 5 6
Comments:________________________________________________________________________________
__________________________________________________________________________________________
If you would like to be contacted about your experience at the Council, please leave your telephone number and an agency representative will call you. Telephone:_____________
Best Time to be Contacted:___________________________________
Thank you for your assistance in helping make the Council a better community action agency. Please return survey to staff.