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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 />❑ ❑ 1 am staying/living with friends or family <br />❑ ❑ 1 am homeless (including staying in a shelter or a motel.) <br />❑ ❑ 1 am living in an apartment or house on my own (or with my children) <br />Abuse <br />3. Have you experienced any further physical abuse since receiving our services? <br />❑ No ❑ Yes <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 />