Veteran Exit Survey
Date
/
Month
/
Day
Year
Date
Veteran name
May we use your first name?
Yes
No
Courtesy of the Staff
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Ease of applying
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Quality of Meals
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Service of Meal Provider
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Has this meal program helped your situation? If so or not, please write a couple of sentences of how or how not.
Any suggestions for improvements?
Thank you for your feedback and for the
privilege to give back to you for your service!
Submit
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