Customer Satisfaction Survey Template
  • Annual Resident Services Survey

    Annual Resident Services Survey

    Resident Experiences
  • Resident Information

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  • Dear Resident:

    As your Resident Experience Team at Decatur Housing, helping you get your needs met is important to us. We'll provide you with the information about services and programs that can help link you with the services and support you choose. To better serve you we need to know what services you currently need or believe you may need in the future. The following information will be kept confidential in accordance with our policies. If you need assistance completing forms or have questions Service Coordinators are available. Please visit us at the DH Community Resource Center (481 Electric Ave, Decatur GA, 30030) at the following times 10:00am-12:30pm or 5:00pm-6.30pm. You can also call 404-270-2100 ext. 8703 or email jjo@decaturha.org to schedule an appointment. Please have your survey completed by Monday September 29th.
  • Service Coordination Acknowledgement

  • I understand that it is my choice whether to use the services (s) available to me through the Resident Service program. I have  received a complete description of the Resident Service program from the Resident Experience team, including a brochure that reviews the service (s) available to me. I understand that i can ask for assistance from my Resident Services team at any time in the future. 

  • I am interested in participating in the Resident Services Program.*
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  • HOUSEHOLD MEMBERS

    Please list all members on you active lease
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  • Service Needs

    Please check the programs that you or other residents would find helpful

  • Information on Entitlement Programs:

  • Assistance with Personal/Family Needs:

  • Personal Development Training:

  • Education Programs:

  • Recreational/Interest Activities

  • Youth Programs & Activities:

  • Assistance with Housing Issues:

  • Confidentiality Agreement

    Confidentiality is protecting another person's right to privacy.
  • As the Resident Experience Services Team, we agree to protect your right your privacy. To ensure that residents have trust in their relationsahp with the Resident Service Coordinators, information revealed to the Resident Coordinators will not be discussed with anyone else. 

    This means that your personal information is not revealed to anyone, including property staff or your family, without your written permission, unless required by law. 

    We utilize a "Release of Information" form to obtain this permission. As needed, the Resident Service Coordinators will request that you complete and sign this form. The Properly executed form will allow Resident Coordinators to discuss your service needs and desires with the specified community service provider, family members, physicians, and/or other individuals in order to link you to programs and services that will assist you in achieving and maintaining self-Sufficiency. 

    Exceptions to the right of confidentiality 

    *Federal and orState law may require us to disclose th efollowing information: 

    *Abuse or neglect of any kind, including physical, mental and financial. 

    *Endangerment-residents who are a danger to themselves or others. 

    *Fraudulent activities and other violations of the law. 

    *information pursuant to a proper court order. 

    *Lease violations. 

    Confidentiality pledge

    As your Service Coordinators, we agree to protect your right to privacy and confidentiality. We will not disclose any information about you without your written permission unless we are required by law to do so.

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