Customer Satisfaction Survey

Name:

Address:

Phone No:

E-Mail Address:

Dates Attended:

Having completed your training, how useful are your travel skills to you?:

   Extremely useful

   Useful

   Somewhat useful

   Not useful

How useful are your Braille skills?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How useful are your typing/computer literacy skills?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How useful are your home economics/daily living skills?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How useful are your industrial arts skills (if applicable)?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How useful was your Remedial Education/GED training (if applicable)?:

   Excellent

   Satisfactory

   Unsatisfactory

   Needs Improvement

   Unsatisfactory

Please rate your overall training at the Center:

Please rate your overall training at the Center:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

Would you recommend potential students to the Center?:

   Yes

   Not useful

   No

Have you adjusted to family life since leaving the Center?:

   Yes

   No

Have you noticed a change in your family’s attitude about blindness since completing your training?:

   Yes

   No

If so, how have they changed?:

Do you participate more in social activities since completing training at the Center?:

   Yes

   No

Do you feel more comfortable in social settings since completing training at the Center?:

   Yes

   No

Rate your present comfort level while participating in social activities:

   Very Comfortable

   Comfortable

   Somewhat Comfortable

   Uncomfortable

Are you currently employed?:

   Yes

   No

If yes, do you work part-time or full-time? (Full-time is defined as 30 hours or more a week.):

   Full-time

   Part-time

If you are working, is the training that you received at the Louisiana Center for the Blind beneficial to you in your employment?:

   Yes

   No

Did you get your job as a result of Louisiana Center for the Blind services?:

   Yes

   No

Are you currently in school?:

   Yes

   No

Did you pursue higher education following your training at the Center?:

   Yes

   No

If yes to either, is the training you received at the Center helpful in your academic endeavors and how?:

What is the most important thing you learned while attending the Louisiana Center for the Blind?:

How would you rate the physical facility (building) while you were in training?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How would you rate the living accommodations during your training?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

Do you use Braille?:

   Always

   Sometimes

   Never

Do you use the computer?:

   Always

   Sometimes

   Never

Do you cook?:

   Always

   Sometimes

   Never

Do you travel independently using the cane?:

   Always

   Sometimes

   Never

If applicable, do you attempt any industrial arts activity or home maintenance projects?:

   Always

   Sometimes

   Never

How would you rate your instruction in your Braille class?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How would you rate your instruction in computer class?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How would you rate your instruction in your home economics/daily living skills class?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

How would you rate your instruction in your cane travel class?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

If applicable, how would you rate your instruction in the industrial arts class?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

Was the feedback provided in your routine “staffings” helpful?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

Please comment on the strengths and/or weaknesses of your training in any area. (Optional):

In which of the following activities did you participate while in training?:

   Rock Climbing

   Hiking

   Water Skiing

   Canoeing

   White Water Rafting

   Picnics

   Roller Skating

   Fishing

   Mardi Gras

   Horseback Riding

   Camping

   Swimming

   Bowling

   Cook-outs

   Gardening

   Dining Out

   Attending Concerts/Plays

   Participating in plays

   Attending movies

   Participating in speaking engagements

   Attending speaking engagements

   Shopping

   Rural travel (walk to Grambling)

   Legislative work (state and/or national)

   Festivals

   Conventions (state and/or national)

   Trips/Sightseeing/Museums

   Touring visitors through the Center

   Chopping/decorating Christmas trees

   Visiting other Centers

   Other

Which of the above activities most helped to build your confidence?:

Since leaving the Center, has your attitude about blindness changed?:

   Yes

   No

If so, how did your attitude change?:

Do you feel more comfortable about being blind?:

If your attitude changed, did Seminar class play a part in this change?:

   Yes

   No

What topics did you find most beneficial?:

Rate the effectiveness of Seminar in changing your attitudes about blindness?:

   Excellent

   Satisfactory

   Needs Improvement

   Unsatisfactory

Are you a member of the National Federation of the Blind?:

   Yes

   No

Are you a member of another consumer organization for blind people?:

   Yes

   No

If yes to either, are you an officer at either the local, state or national level?:

   Yes

   No

If so, what position do you hold?:

Are you involved in any community or civic organizations (Lion’s club, church groups, etc.)?:

   Yes

   No

Do you volunteer for your church or local charities?:

   Yes

   No

Do you use the Center as a resource, or for encouragement and re-enforcement?:

   Yes

   No

If you could change any aspect of your training, what would it be?: