Impact Assistance Survey
Please complete this survey to help us assess the effectiveness and impact of the assistance you received. Your feedback is valuable for improving our programs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location (City, State or Region)
*
Which type of assistance did you receive?
*
Please Select
Financial Support
Food Supplies
Medical Aid
Shelter/Housing
Educational Support
Other
How satisfied are you with the assistance provided?
*
1
2
3
4
5
Please rate the following aspects of the assistance you received:
*
Rows
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Timeliness of support
1
2
3
4
5
Quality of assistance
6
7
8
9
10
Communication with staff
11
12
13
14
15
Respect and dignity
16
17
18
19
20
Accessibility of assistance
21
22
23
24
25
Did the assistance meet your needs?
*
Fully met my needs
Partially met my needs
Did not meet my needs
What positive changes have you experienced as a result of the assistance? (Select all that apply)
Improved well-being
Better access to resources
Increased sense of security
Enhanced skills or knowledge
Other
What challenges or difficulties did you face during or after receiving the assistance?
What suggestions do you have for improving our assistance programs?
Submit Survey
Should be Empty: