Input Survey CCMEP

Client Name*

Program

Date*

Date

Please help us improve our services by answering the following questions: Write out any general suggestions you have that would help Goodwill improve our services:

Write out any general suggestions you have that would help Goodwill improve our services

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Orientation (First day in the program - paperwork and presentation)

Presenter was polite*

I understood the information presented*

The paperwork was easy to fill out*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

In Take/Service Plan (Meeting with Case Manager to develop job plan)

Case Manager was polite and respectful*

I understood the information presented*

The paperwork was easy to fill out*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Training and Workshops

Presenter was polite and respectful (if applicable)*

I understood the information presented*

The training classes will be or were helpful in getting a job*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Career Development and Individual Service Plan

Case Manager was polite and respectful*

I understood the information presented*

The paperwork was easy to fill out*

My Career Development Plan will help me obtain full time employment*

My Case Manager helped me to define my goals and Research career options*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Work Experience

Site Supervisor was polite and respectful *

The worksite was clean and safe*

The skills program will be or was helpful in getting a job*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Case Management (Meeting with your Case Manager)

Case Manager was polite and respectful*

My concerns were addressed in a timely manner*

Goodwill made accommodations as necessary*

I knew how to file a complaint*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Safety

I felt safe while at Goodwill*

The buildings and facilities were easy to navigate*

I knew what to do in an emergency *

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Counseling - Anazao (Put N/A if Not Applicable)

Counselors were polite and respectful *

Counseling helped or will help me get a job*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

GED Tutoring ASPIRE (Put N/A if Not Applicable)

Presenter was polite and respectful*

I understood the information presented *

The tutoring was helpful in passing the GED exams*

Comments

Rate the following areas, 5=excellent, 4=above average, 3=good, 2=fair, 1=unsatisfied, 0=does not apply

Incentive Program (not applicable for all programs) On a scale of 1-5 (being most important, being somewhat important, and being not important), answer the question.

How important was the Incentive Program to you in completing your goals?*

Would you have completed the goal is no incentive was offered? *

Did you complete the goal quicker because of the incentive? *

Did you retain your job partly because of the incentive?*