Client Feedback Survey

United Way Feedback Form

2021/2022 Legal Aid Survey

Demographic Information: Please share some information about yourself. Do not write your name anywhere on the survey; the information you provide is confidential!

1. Choose one "Site Location" (Optional)

You now have the ability to choose a site for your survey. It is the responsibility of the program to inform the participant which site they should be choosing. The purpose of the site functionality is for organizations that have more than one location to choose the location that the participant is attending. The sites in i-CResults are marked 1-10. It is your organizations responsibility to determine which sites are which. By choosing to use this site function you will be able to see your results by filtering for that particular site, allowing you to compare results by site.
2. Your gender: *
3. Your Age: *
4. How would you describe yourself? (Check one) *
5. Household Income: *
Homeless *
7. Are you or have you ever been a member of the Armed Forces *
8. What is the primary Language spoken in the home *

DIRECTIONS: There are Sections in this survey; please answer each question as indicated below:

Section 1. Stress Reduction

9. Did you feel as though someone was able to help you? *
10. Did you feel listened to? *
11. Did you experience some type of stress relief in knowing where to seek assistance and/or services? *

Section 2. Education

12. Did you feel you were provided a better understanding of your legal rights? *

Section 3. Resource Referral

13. Did you get the necessary referrals to other community resources that you need? *