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Department of Recreation - Senior Programs, Customer Satisfaction Survey
Instructions: Please select the program or center you would like to evaluate. Then help us provide seniors with the best possible service by giving us your feedback. Note: Submit this form for each program or center you wish to evaluate.
1) I would like to submit evaluative comments on the following program or center:
 

2) Please rate the following: 1=never 2=seldom 3=usually 4=always
a) The Senior Center/Neighborhood Senior Program meets my expectations.
 
  1 2 3 4
b) The leadership of the Senior Center/Neighborhood Senior Program is good
 
  1 2 3 4
c) The facility is well maintained and comfortable.
 
  1 2 3 4
d) I would recommend this Senior Center/Neighborhood Senior Program to a friend.
 
  1 2 3 4
3) What have you most enjoyed about this Senior Center/Neighborhood Senior Program?
 
4) Did your participation improve or will it improve your health or well being?
 
5) What would you like to see improved?
 
6) What suggestions do you have for new programs?
 
7) How did you first find out about the Senior Center/Neighborhood Senior Program?
 

8) Optional
Name
Address
City
State
Zip
Phone
Age
Gender
Date 22/11/2009
We appreciate your participation in our programs and value your comments and suggestions. Thank you for taking the time to give us your feedback.
Last edited:01/28/2003  
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