Success Fund Evaluation

Success Fund Evaluation

Your feedback is important to us. Please provide us with honest responses so we can best serve you and our community.
Name

First NameLast Name
JotForm Link On-linePhoneEmail/Scan CopyMail Paper CopyQR CodeCIP Website
Yes (please explain below)No
Please explain here:
YesNo
NewspaperRadioTVPoster/FlyerCO-Worker/FriendAFC/Nursing FacilitySenior CenterAgency on AgingMiWorksCIP WebsiteSocial MediaOther (please type below)
Other: Please type here
YesNo
Please explain your answer below:
Would you recommend applying to the Success Fund to a DCW co-worker or DCW friend who is experiencing barriers or obstacles?

1

2

3

4

5

1 is Unlikely, 5 is Likely
How would you rate your overall experience?

1

2

3

4

5

1 is DIssatisfied, 5 is Satisfied
How would you rate the application process?

1

2

3

4

5

1 is Dissatisfied, 5 is Satisfied
If you filled out the application through JotForm, what was the level of use? (Skip if you did not use JotForm)

1

2

3

4

5

1 is Difficult, 5 is Easy
3-5 Business Days5-7 Business Days7-10 Business Days10-14 Business DaysOther (please type below)
If you choose "Other", please explain your answer here:
How or where can we disperse Success Fund information to more caregivers/DCW who may be in need of assistance?
YesNo, but now I do
Funding is made possible through a grant awarded to MSU IMPART Alliance from the Michigan Department of Health and Human Services using American Rescue Plan Act/Home and Community Based Services Spending Plan funds.
YesNo
Should be Empty:

Success Fund Evaluation

Funding is made possible through a grant awarded to MSU IMPART Alliance from the Michigan Department of Health and Human Services using American Rescue Plan Act/Home and Community Based Services Spending Plan funds.