Client Satisfaction Survey

Questions marked with a * are required

100%

Did SELF HELP INC. help you or anyone in your household in the past 12 months?

Yes

No

Which SELF HELP INC. services have you used in the past 12 months? Check all that apply

Fuel assistance (LIHEAP)

Head Start

Attleboro Food Bank

Weatherization Assistance Program (WAP)

Heating Emergency Assistance Retrofit Task Weatherization Assistance Program (HEARTWAP)

Appliance Management Program (AMP)

Coordinated Family and Community Engagement

Community Outreach- (Information and Referral Services)

Brockton Lead Abatement Program

VITA-Tax Assistance Program

Hand-In-Hand Elder Case Management

Parent Child+ Home Visiting

SNAP Application Assistance

COVID Safe Cooling (AC Distribution)

EARLY HEAD START

Other

N/A

How did you learn about SELF HELP INC ?

Another person told me about it

Staff at another agency or organization referred me

I found Self Help Inc’s website

I saw a flyer or poster

I heard about it on TV or radio

On Social Media (Facebook/Twitter)

Other

Please Tell Us a Little Bit About Your Experience with Self Help Inc. and our Staff

I feel welcome at the SELF HELP INC. office or when I talk with staff on the phone.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

SELF HELP INC. staff understand my needs and culture.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

SELF HELP INC. staff treat me with respect and do not judge me.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

SELF HELP INC. staff support me to make my own decisions

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

I am satisfied with how SELF HELP INC. staff have treated me.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

My situation is better because of the help SELF HELP INC. gave me.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

My finances are more stable because of help from SELF HELP INC.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

I can take care of my family or myself better because of the assistance I received from SELF HELP INC.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

SELF HELP INC. helped me learn about helpful resources near where I live.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

I am satisfied with the help I got from SELF HELP INC.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

Did anything make it hard for you to get assistance from SELF HELP INC.?

Hours

Parking

Transportation

Child care

Disability

I felt embarrassed

I felt overwhelmed

Immigration or citizenship status

I couldn't understand what the staff person was saying

Information was too hard to read

Too much paperwork

Tired of answering the same questions over and over again

Other

N/A

How could SELF HELP INC. improve? Please give us your suggestions:

What other assistance and/or programs would you like SELF HELP INC. to offer in the future?

In general, do you feel that you are………

Better off than you were 1 year ago

Worse off than 1 year ago

About the same as you were 1 year ago

Other

Where do you live?

Abington

Attleboro

Avon

Bridgewater

Brockton

Canton

Dedham

East Bridgewater

Easton

Foxboro

Franklin

Hanson

Holbrook

Mansfield

Middleboro

Needham

Norfolk

North Attleboro

Norton

Norwood

Plainville

Randolph

Raynham

Rockland

Sharon

Stoughton

Walpole

West Bridgewater

Westwood

Whitman

Wrentham

Other

What is your Zip Code?

Can SELF HELP INC. use your comments and testimonial on our website or in our future marketing efforts?

YES!

No

If you would like someone to reach out to in regard to your responses, please provide your contact info. below

First Name

Last Name

Phone

Email Address

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