Client Survey

This form is sent to all of the families we help approximately three months after receiving assistance. Please feel free to answer as many or as few that you choose. We keep all of these answers confidential. In cases where we wanted to learn more or to attribute it to you, we will reach out and only proceed with your permission. If you have any questions, please contact us.

Reflection Questionnaire

Name
Email
What Event Led You to Applying for Financial Assistance?
Check as many as apply
Did you have health insurance coverage during this time?

What categories did you use the funds granted for?
Would you recommend this organization to another family?
Rank our application process from 1 (desperately needs improvement) to 5 (excellent)
On a scale of 1 (did nothing to help) to 5 (life-changing help), rank the help you received.
On a scale of 1 (did nothing to help) to 5 (life-changing help), rank the impact of the help received.
Would you be interested in sharing your story?

Demographic Information (100% optional)

Military Service