Standard form #27B/j

Please take a few minutes to fill out this
questionaire. All answers will be kept
confidental and are used only for research
purposes.

1: How did you hear about us?
__________________________________________

2: Did you enjoy your overall experience?
___ Yes ___ No

If not, why not? _________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

3: Is this your first protest with this
(office)? ___ Yes ___ No

4: On a scale of 1 to 10, please rate the
following aspects of our service:

(circle one)

Representative access 1 2 3 4 5 6 7 8 9 10
Employee politeness 1 2 3 4 5 6 7 8 9 10
Toilet availability 1 2 3 4 5 6 7 8 9 10
Snacks 1 2 3 4 5 6 7 8 9 10
Parking 1 2 3 4 5 6 7 8 9 10

5: Would you come back and protest again?
___ Yes ___ No

6: How can we make future protests more
fulfilling for you? ______________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Thank you for your time. Your answers will
help (this office) become more responsive to
protester needs as part of our service goals.

    

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