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EXHIBIT C <br />CLIENT SATISFACTION SURVEY <br />FVLC Evaluation Survey <br />Hello my name is ________ from the Family Violence Law Center. You received ______ (type of services) <br />from us in the past, and we are calling some of our previous clients in order to find out how they are <br />doing. I would like to ask you a few questions that are part of a short five minute survey that will help us <br />in our efforts to improve our services to better help our clients and the community. Your answers and <br />identity will be kept confidential. <br />Client Information (Anonymous and Confidential- pulled from database report) <br />Initials:____ City:__________ Month:______ # Contacts:_________ <br />Services Received: □ Intake □ Legal □ FVIU □ Family Caseworker □ MRT □ HEAL <br />□ DOESN’T REMEMBER RECEIVING SERVICES □ REFUSED TO RESPOND <br />The following sets of questions are going to ask you to compare your current situation to your <br />situation when you first received our services. <br />Living Situation <br />1. Did you have to move because of the abuse? <br /> □ Yes □No <br />2. Please describe your living arrangements. <br /> Before After <br /> □ □ I am staying/living with friends or family <br /> □ □ I am homeless (including staying in a shelter or a motel.) <br /> □ □ I am living in an apartment or house on my own (or with my children) <br />Abuse <br /> <br />3. Have you experienced any further physical abuse since receiving our services? <br /> □ No □ Yes <br /> <br />4. Have you experienced any further emotional abuse since receiving our services? <br /> □ No □ Yes <br />5. If yes, is the current abuse occurring with the same person? <br /> □ No □ Yes <br />PROGRAM SPECIFIC QUESTIONS (ask applicable questions only) <br /> <br /> <br />238