Statewide Assessment Survey Form
Share your statewide assessment feedback. Please answer the questions based on your experience and observations.
Respondent Information
Respondent Name
*
First Name
Last Name
County/Region
*
Please Select
Adams
Benton
Clark
Dane
Franklin
Green
Jefferson
Kenosha
La Crosse
Milwaukee
Ozaukee
Racine
Rock
Sauk
Waukesha
Other
Preferred Contact Email
*
example@example.com
Statewide Assessment Questions
Overall satisfaction with statewide services/programs
*
Very dissatisfied
1
2
3
4
Very satisfied
5
1 is Very dissatisfied, 5 is Very satisfied
Perceived accessibility
*
Very difficult to access
1
2
3
4
Very easy to access
5
1 is Very difficult to access, 5 is Very easy to access
Timeliness of service delivery
*
Very slow
1
2
3
4
Very timely
5
1 is Very slow, 5 is Very timely
Clarity of communication
*
Very unclear
1
2
3
4
Very clear
5
1 is Very unclear, 5 is Very clear
Priority Feedback
Area-by-area priority evaluation
*
Rows
Poor
Fair
Good
Very Good
Excellent
Service availability
1
2
3
4
5
Communication
6
7
8
9
10
Responsiveness
11
12
13
14
15
Overall experience
16
17
18
19
20
Most important improvement suggestion
*
Additional priority feedback
Submit Survey
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