Adult Day Center Grant Survey Form
Please complete this brief survey to help us assess the impact and effectiveness of the Adult Day Center grant program.
Adult Day Center Name
*
Center Location (City, State)
*
Which best describes your center’s primary use of the grant funds?
*
Facility improvements
Staff training or development
Program expansion
Equipment or supplies
Other
How would you rate the impact of the grant on your center’s services?
*
1
2
3
4
5
Please indicate the level of improvement in the following areas as a result of the grant.
*
Rows
No Improvement
Some Improvement
Significant Improvement
Client engagement
1
2
3
Program quality
4
5
6
Staff satisfaction
7
8
9
Community outreach
10
11
12
How satisfied are you with the grant application process?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Did you encounter any challenges in utilizing the grant funds?
*
No
Yes
If yes, please briefly describe the challenges faced.
What additional support would help your center maximize the benefits of the grant?
Any other comments or suggestions?
Submit Survey
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