Beneficiary Satisfaction Assessment Questionnaire
Please complete this questionnaire to help us evaluate and improve our services. Your feedback is valuable and will remain confidential.
Full Name
*
First Name
Last Name
Email Address
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Which program or service did you benefit from?
*
Please Select
Food Assistance
Shelter Support
Health Services
Education Support
Employment Assistance
Other
How did you hear about our program or service?
Referral
Community Outreach
Social Media
Website
Other
Please rate your satisfaction with the following aspects of the service you received.
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Ease of application process
1
2
3
4
5
Timeliness of assistance
6
7
8
9
10
Quality of support provided
11
12
13
14
15
Staff professionalism and courtesy
16
17
18
19
20
Clarity of information received
21
22
23
24
25
Accessibility of the service
26
27
28
29
30
Overall, how satisfied are you with the support you received?
*
1
2
3
4
5
Did the assistance you received meet your needs?
*
Yes, completely
Partially
No
Would you recommend our program or service to others in need?
*
Yes
No
What did you find most helpful about our program or service?
How can we improve our program or service?
Please provide any additional comments or suggestions.
Submit Feedback
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