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STAKEHOLDER SURVEY

Please take a moment to fill out the form.

1. Accessibility and Availability

Ease of making referral to us
Accessibility and availability of services
Timeliness of staff communication of Client/program information

2. Program Quality

Community Education
Advocacy/Public Policy
Life Skills training (Independent Living, Low Vision, Personal Adjustment, Disability Benefits Assistance,)
Benefits Analysis
Community Employment
Youth Development (Job Link, High School/High Tech)
Assistive Technology

3. Client Information

Achieved desired outcome
Promotion of Clients self-determination/self-sufficiency
Usefulness of staff communication of Client information

4. Staff

Courtesy
Professionalism
Level of Cooperation
Appropriateness of our referral recommendation
Overall communication

5. Overall Satisfaction

Value of Service
Quality of Service
Effectiveness of Programs
Overall Satisfaction

10. The following information is optional unless you requested us to contact you or send information:

Thanks for submitting!

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