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Consumer Survey

 

Check the letter that corresponds with your answer to each question:


1. How long have you been a consumer at CIL Disability Resource Center?
A) Less than six months
B) Six months to twelve months
C) Thirteen months to twenty four months
D) Twenty five months or more


2. Who set your independent living goals?
A) I set them myself
B) The Center for Independent Living staff member and I set them together
C) A Center for Independent Living staff member set them
D) I don't know who set them


3. Are the services you are receiving making you feel more independent?
A) Yes, definitely helping
B) Yes, some what
C) No, I don't think so
D) No, definitely not


4. Did the Center for Independent Living Disability Resource Center staff members treat you with courtesy and respect?
A) Yes, definitely
B) Yes, I think so
C) No, I don't think so
D) No, definitely not


5. Overall, how satisfied are you with the services you are receiving from Center for Independent Living Disability Resource Center?
A) Very satisfied
B) Mostly satisfied
C) Mildly dissatisfied
D) Very dissatisfied


6. Check any of your current needs below:
Transportation
Housing
Employment
Skills Training
Social
Recreational
Educational
Other
Other:


Comments:


NOTE: If you would like to be contacted with response to your comments, place in the comment box above the following information:
Name:
Address:
Email:
Telephone: