MENU
CLOSE
Who We Are
Our Mission
Our History
Our Team
Careers
Board of Directors
Frequently Asked Questions
Careers
What We Do
Violence Prevention & Response
Domestic Violence Services
Center for Survivors of Sexual Violence
Crisis Hotline
Economic Empowerment
Permanent Supportive Housing
HomeShare
Homeless Crisis Response Program & Rapid Rehousing
Life Skills Support
Women & Girls Leadership
Girls LEAD!
In-School Programming
Evening & Weekend Activities
Summer Camp
AMEND Together
Sojourn Leadership Academy
Circle of Influence
Social Justice Advocacy
Policy Priorities
YWomen Vote
Community Outreach & Education
How To Help
Donate
Imagine Circle
Capital Campaign
Volunteer
YWish List
Shop for a Cause
News & Events
Contact Us
Blog
Podcast
Media On a Mission
Newsletter & Annual Report
Signature Events
Women of Influence
2023 Registration
2022 Honorees
Until Justice Just Is
Purple Paws: Preble Pets Against Domestic Violence
Domestic Violence Awareness Month
Voices Against Violence
#PassThePurseDYT
Sexual Assault Awareness Month
Human Trafficking Awareness Month
Y-Dub Discussions
Special Happenings
150th Anniversary
Black History Month
Renovating Lives: Floor by Floor
#GivingTuesday
Careers
Donate
Quick Escape
Children’s Programming Satisfaction Survey
Home
Children’s Programming Satisfaction Survey
A-
A
A+
Children’s Programming Satisfaction Survey
Which of the following services did your children participate in (check all that apply):
Drop-in Child Care
Kids Group
Case Management
Monthly Programming Activities
Other (describe below)
If you checked "Other" above, please describe:
Overall, I think Drop-in child care has been beneficial for my child(ren).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall, I think the Kids Group has been beneficial for my child(ren).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall, I think going the activities hosted by the Children’s Program has been beneficial for my child(ren).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall, I think Case Management has been beneficial for my child(ren).
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Children’s Program staff treats me with respect.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Children’s Program staff are caring and supportive.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall, I would say that I feel comfortable with the staff.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
What do you like best about the Children’s Program?
What would you change or like to see improved about the Children’s Program?
Would you recommend the Children’s Program to other shelter clients? Why or why not?
Which of the following services did your children participate in (check all that apply):
Education assistance (enrolling in school, tutoring, etc.)
Clothing assistance
Food assistance (food pantry referrals, etc.)
Transportation assistance (bus tokens, transportation for those with physical disability)
Mental health services
Affordable medical care
Other (describe below)
If you checked "Other" above, please describe:
How would you rate the safety of the Drop-in Room overall?
Excellent
Good
Fair
Poor
How would you rate the cleanliness & appearance of the Drop-in Room?
Excellent
Good
Fair
Poor
Demographic Information
The following questions are optional and will help us know who is using our services so we can continue to improve our programs to meet the needs of all clients.
How many children stayed with you in shelter?
What ethnicity does your child(ren) identify as?
What is the gender identity of child(ren) (if multiple children, use text box below to specify identity and quantity)
Female
Male
Transgender Male to Female
Transgender Female to Male
Gender Fluid
Non-binary
An identity not listed (please specify below)
Prefer not to disclose
If you checked "Other" above, please describe:
If you have multiple children, please specify identity and quantity here:
What is your child(ren)'s age?
Additional Comments or Concerns: