Strat Survey Form
Please be assured that your survey answers will remain completely confidential. Responses
received from these surveys will be used to formulate our Strategic Plan for 2025 through
2027. Your feedback will directly impact how we focus our efforts in these coming years. We
have included a prepaid envelope for your convenience. We appreciate your assistance.
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Name, Email, Phone number *
Gender *
County *
Please check all that apply. I am:
Please check all that apply. I am affiliated with:
YOUR PERCEPTION OF NWGA CIL
This section asks how you see NWGA CIL. These answers
help us gauge our outward-facing efforts, such as the effectiveness of our outreach.
What types of disabilities do you think are eligible for our services? Check all that apply:
 *
Required
What age range of people do you think are eligible for our services? Check all that
apply:
 *
Required
What services, programs and classes do you think we provide?
 *
What feedback have you heard about NWGA CIL from others in the community?
 *
COMMUNICATION
This section asks how effective our communication is currently, and
will give insight into ways we can improve how we communicate to you—our community.
Do you feel you are adequately informed about NWGA CIL and our services, programs,
classes, events, etc.?
 *
Where do you receive updates about NWGA CIL?
Check all that apply:
 *
Required
How did you find out about NWGA CIL?
 *
OUR EFFECTIVENESS
These questions ask your opinion on how well our current services &
programs serve the community, and what we can improve upon.
What do we do well as an independent living center?
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What can we do better?
 *
YOUR VISION OF OUR FUTURE
This section asks questions that will help us formulate our
plan for the next three years.
What services, programs and classes would you like to see us provide?
 *
What disability issues in our community do you think need to be addressed?
 *
Do you have any additional comments?
 *
OPTIONAL
Name
Phone or Email:
What would you like to discuss with us?
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