DDPC Consumer Satisfaction Survey

1.   Project Activity  * 2.   Please check the category that best describes you:  * Individual with a disability Family Member Other PLEASE CIRCLE EITHER YES OR NO TO TELL US YOUR OPINION ABOUT THE FOLLOWING STATEMENTS: 3.   I (or my family member) was treated with respect during this project activity.  * Yes No 4.   I (or my family member) have more choice and control as a result of this project activity.   * Yes No 5.   I (or my family member) can do more things in my community as a result of this project activity.  * Yes No PLEASE SELECT THE ANSWER THAT BEST DESCRIBES YOUR OPINION. 6.   I am satisfied with this project activity.  * strongly agree agree disagree strongly disagree 7.   My life is better because of this project activity.  * strongly agree agree disagree strongly disagree 8.   What has been helpful or not helpful about this project? THE FOLLOWING ARE OPTIONAL QUESTIONS TO BE USED WHEN A PROJECT ACTIVITY INCLUDES RIGHTS AND PROTECTION ISSUES. 9.   Because of this project activity, I (or my family member) know my rights. Yes No 10.   I (or my family member) am more able to be safe and protect myself from harm as a result of this project activity. Yes No * fields are required.

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