Consumer Satisfaction Survey
Thank you for participating in the services provided by the Independent Living Resource Center (ILRC). Please select the best answer that rates the services you received from the agency during your time as a consumer.
* Required
1. How long have you been a consumer at the ILRC?
*
less than six months
six months to 12 months
13 months to 24 months
25 months or more
Other:
2. Who set your independent living goals?
*
I set them myself.
The ILRC staff member and I set them together.
The ILRC staff member set them.
I don't know who set them.
Other:
3. Are the services you are receiving making you more independent?
*
Yes, definitely helping.
Yes, somewhat.
No, I don't think so.
No, definitely not.
Other:
4. Did the ILRC staff members treat you with courtesy and respect?
*
Yes, definitely.
Yes, I think so.
No, I don't think so.
No, definitely not.
Other:
5. Overall, how satisfied are you with the services you are receiving from the ILRC?
*
Very Satisfied.
Mostly Satisfied.
Mildly Dissatisfied.
Very Dissatisfied.
Other:
Comments:
Your answer
I am interested in further information from the ILRC in the following areas:
(Check all that apply)
ACCESS
Amplified telephones for the Hard-of Hearing
Subsidized housing lists in Clay, Duval, St. Johns, Baker & Nassau County
Volunteering
Sign language interpreting services
Services for individuals who are deaf
Temporary loan of medical equipment
Transportation services through JTA
Resources for rent and/or utilities assistance
Assistance with Medicaid Applications
Assistance with Food Stamps (SNAP) Applications
EDUCATION
Peer Counseling
How Social Security is affected by employment?
Wage/Employment reporting to Social Security Administration
Self-Advocacy skills
Mentoring youth with disabilities
Youth Advisory Council as I am between the ages of 12 & 25
EMPLOYMENT
Assistance in finding a job
Resume writing
Job applications
Interviewing skills
Free lunches for new employees
Does The ILRC of Northeast Florida have permission to add you to our monthly email newsletter?
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Other:
Your contact information below will be used to contact you with the additional information you requested on the areas marked above.
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Your answer
Phone Number
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Email Address
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