Satisfaction and Interest Survey

Satisfaction and Interest Survey

The Clinton County Board of Developmental disabilities strives to provide you or the individual you care for with the best possible services. We would like to know how we are doing currently so that we can continue to develop services and offerings important to you.
Who is completing this survey?*

Person receiving servicesParent/Guardian/Family MemberPaid ProviderPrefer not to answer
What services do you or your family receive from CCBDD? (Check all that apply.)*

Community IntegrationEarly InterventionEducational/School AgeEmployment FirstFamily Support ServicesResidential/Housing/Supported LivingService and Support AdministrationSpecial OlympicsUnsure
What services do you or your family receive from CCBDD (Check all that apply)*

Community IntegrationEarly InterventionEducational/School AgeEmployment FirstFamily Support ServicesResidential/Housing/Supported LivingService and Support AdministrationSpecial OlympicsUnsure
Are CCBDD staff understanding of your needs or the needs of the individual you care for?

YesNo
If no, please explain:
Are CCBDD services meeting your needs or the needs of the individual you care for?

YesNo
If no, please explain how we could do better:
How do you currently receive information about CCBDD services or events?

EmailFacebook-Clinton County Board of DDCCBDD websiteFacebook-Early InterventionOne Call NowMail
How do you currently receive information about CCBDD services or events?*

EmailFacebook-Clinton County Board of DDCCBDD websiteFacebook-Early InterventionOne Call NowMail
How could we communicate better?
We plan to distribute a newsletter via email and will collect your email address below.
What information sessions or activities are you interested in?

Advocacy and RightsCCBDD services overviewEmploymentHealth and NutritionHousing/Supported LivingIEP/School SupportsIFSP/ISPRecreation/SocializingSafetyTechnologyWaiversParent Support GroupVolunteering
What information sessions or activities are you interested in?

Advocacy and RightsCCBDD services overviewEmploymentHealth and NutritionHousing/Supported LivingIEP/School SupportsIFSP/ISPRecreation/SocializingSafetyTechnologyWaiversParent Support GroupVolunteering
What other topics are of interest to you?
What else should we know?
Please provide your email address to receive newsletters and information:
example@example.com
OPTIONAL: Please provide your name and phone number if you want to be contacted regarding your responses to this survey:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Thank you

We thank you for taking the time to help us provide better services!
Should be Empty:

Satisfaction and Interest Survey

Thank you