Client Survey

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CLINCH VALLEY COMMUNITY ACTION, INC.

Thank you for taking a few minutes to fill out this Client Survey. You are Important to Clinch Valley Community Action (CVCA).

This survey is intended for individuals that have received services from CVCA in the past.

We value your response! Please complete and hit submit at the end of the survey.

1. When I entered the CVCA facility, I felt welcomed.pick one!

YesNoN/A – services were provided in my home or outside of Clinch Valley Community Action offices

2. The facilities were clean.pick one!

YesNoN/A – services were provided in my home or outside of Clinch Valley Community Action offices

3. My need was addressed in a timely manner.pick one!

YesNo

4. I was treated with respect.pick one!

YesNo

5. My needs were met or, I was referred to another appropriate agency/ service.pick one!

YesNoIf not, I was referred to another appropriate agency/service.

5. I was informed about other CVCA services.pick one!

YesNo

6. I would recommend CVCA to friends and family.pick one!

YesNo

7. If not, please provide the reason that you would not recommend CVCA.more details

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8. Which program or programs did CVCA assist you with?pick one!

Head StartEarly Head StartEmergency ServicesRetired Senior Volunteer ServicesSenior Companion ServicesProject DiscoveryFamily Crisis ServicesVITA Program ( Volunteer Income Tax Assistance)Community ServicesCommunity CorrectionsCommunity SafetyVHDA / Section 8 / Rental Voucher ProgramWeatherization ProgramRental Prevention/ CHREP ProgramIPR In Door Plumbing Rehab ProgramCooling Assistance ProgramUSDA – Section 504 Home Repair/ Loan Program

9. I would be willing to participate in a discussion group if available to help CVCA continue to improve services. Please provide name and contact information.

Name, Address and Phone #

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Emaila valid email

10. Comment: How can we better serve you? Are there any other services that you would like to see CVCA provide?more details

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