Program Member Satisfaction Assessment Form
Help us improve by sharing your honest feedback about your experience in our program.
Full Name
First Name
Last Name
Email Address
example@example.com
How long have you been a member of the program?
*
Please Select
Less than 3 months
3-6 months
6-12 months
More than 1 year
Overall, how satisfied are you with the program?
*
1
2
3
4
5
Please rate the following aspects of the program:
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Program content
1
2
3
4
5
Communication from staff
6
7
8
9
10
Quality of materials/resources
11
12
13
14
15
Accessibility of sessions
16
17
18
19
20
Support from staff
21
22
23
24
25
Which program activities have you participated in? (Select all that apply)
Workshops
Webinars
Networking events
Mentoring sessions
Other
How likely are you to recommend this program to others?
*
Not likely at all
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not likely at all, 10 is Extremely likely
What do you value most about the program?
What improvements or changes would you suggest for the program?
Do you have any additional comments or feedback?
Submit Feedback
Should be Empty: