WEB Customer Satisfaction Form |

Customer satisfaction form

How are we doing? RCAC depends on your feedback to maintain and improve service quality. Your comments are important to us, and your opinion counts. If you have received technical assistance or other services from RCAC, please complete this evaluation form.

Your information (optional)

*Required field(s) are indicated by an .**
First Name
Last Name
Organization

* Date(s) of Activity	/ / (MM/DD/YYYY)
Date(s) of Activity	/ / (MM/DD/YYYY)
Date(s) of Activity	/ / (MM/DD/YYYY)
* Event Location
RCAC Staff Person
Briefly describe the nature and content of the technical assistance, training or other service that you received:
How useful was the time you spent with RCAC staff?
How was the assistance or training useful ...
How useful was the time you spent with RCAC staff... to you?
How useful was the time you spent with RCAC staff... to your agency?
How useful was the time you spent with RCAC staff...to the overall program/project as a means of serving low-income families?
What assistance or training do you feel you need next?

May I share your specific comments with the RCAC staff person that provided your technical assistance or training?
Phone	XXX-XXX-XXXX
E-mail
	Check if you're not a robot.