Confidential Program Improvement Survey

Please help us to improve our programs and services

Your comments are very important to us and answers are completely confidential. You may fill out this survey online today, or later, or request a paper survey to leave with staff when complete or return to us in a self-addressed and stamped envelope.

Anything we are doing well or that we could do better or improve, please let us know.

The waiting room and atmosphere at Sylvia's CAC made MY CHILD feel comfortable

Strongly agree	Agree	Disagree	Strongly disagree

The waiting room and atmosphere at Sylvia's CAC made ME feel comfortable

Strongly agree	Agree	Disagree	Strongly disagree

The cultural beliefs of my child and my family were respected at Sylvia's CAC

Strongly agree	Agree	Disagree	Strongly disagree

I was treated with respect

Strongly agree	Agree	Disagree	Strongly disagree

The staff made my child feel safe

Strongly agree	Agree	Disagree	Strongly disagree

I am happy and satisfied with the services my child and I received

Strongly agree	Agree	Disagree	Strongly disagree

The location of Sylvia's CAC was convenient to get to

Strongly agree	Agree	Disagree	Strongly disagree

Staff answered my questions during our visit

Strongly agree	Agree	Disagree	Strongly disagree

Household income

There is no cost to families for any service at Sylvia’s CAC. Sharing your income, however, helps us qualify for grants and other funding sources.

Our household income is:

$0-$25,000

$25,001-$75,000

$75,001-$125,000

$125,000 +

My child qualifies for free or reduced lunch at school

Yes

Overall rating of our services (1=poor, 5=excellent)

Additional comments or concerns:

Confidential Program Improvement Survey

Please help us to improve our programs and services

Household income

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