Community Club Member Satisfaction Survey
Thank you for being a member of the Capabilities Community Club.  Our goal is to help you successfully achieve and sustain your goals.  
Please take a few minutes to complete this survey. Your feedback helps us serve you better.
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1. Full Name:
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2. Email Address:
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How long have you been a member of the Community Club? *
4. How would you rate Capabilities on... *
Excellent
Very Good
Good
Fair
Poor
Unsure
Communication - Telling me what is going on
Listening Skills - Hearing me
Staff
Outing Choices
My Outing Choices
Feel my Personal Independence has Increased
Being part of the Community
5. How would you rate Capabilities Community Club overall? *
Excellent
Very Good
Good
Fair
Poor
Unsure
_
6. How likely are you to recommend Capabilities Community Club to other people? *
Excellent
Very Good
Good
Fair
Poor
Unsure
_
7. Would you use Capabilities for other services? *
8.  What do we do well?  What are we doing that you find useful? Tell us about someone from Capabilities that went the extra mile for you. *
9. How can we improve the Community Club and our services to you? *
10. Did you know Capabilities has a website? *
11. Would you like to be featured on the website? *
If yes, please supply your contact information: *
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