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How long have you been a part of our program?
 
Less than 6 months
 
6 months to less than 1 year
 
1 year to less than 3 years
 
3 years to less than 5 years
 
5 years or more
 
 
 
Which of program do you use? Select all that apply.
 
Head Start Full Day
 
Head Start Part Day
 
Home Based (Early Head Start/Head Start)
 
Family Child Care
 
Early Head Start Center Based

 
 
 
What was your level of satisfaction with our program so far this year?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
 
 
 
How would you rate your level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
How much do you rate us on the following attributes?
Well Below Average Below Average Average Above Average Well Above Average
Customer service
Professionalism
Quality of 
Understanding customers' needs
Sales staff
Price
 
 
How likely are you to recomment our services to other families?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
How likely is it that you would recommend our [PRODUCTS/SERVICES] to a friend or colleague?
 
Very likely
 
Somewhat likely
 
Neutral
 
Somewhat unlikely
 
Very unlikely
 
 
 
Do you have any suggestions for improving our SERVICES?
   
 
 
 
What best describes your employment status?
 
Employed full-time
 
Employed part-time
 
Self-employed
 
Not employed, but looking for work
 
Not employed, not looking for work
 
Retired
 
Student
 
Military
 
Homemaker
 
Prefer not to answer
 
Other