Client Exit Survey

Little City Foundation is committed to continuously reviewing and improving our services. The information you provide regarding your experience with Little City Foundation services and decision to leave our services will help us make changes to our service provision that will continuously strengthen our program and services.

What programs and/or services did you or your family member receive from Little City Foundation? Please check all that apply.

What programs and/or services did you or your family member receive from Little City Foundation?

Please check all that apply.

	ChildBridge Children's Group Home
	ChildBridge Center for Education
	Children's Home Based
	Adult Home Based
	Foster Care
	Adult Residential CILA
	Adult Residential CLF (South and West Building)
	Adult Residential SLA
	Vocational Services
	Senior Day Programming
	Center for the Arts
	Horticulture Center
	Other Other

How would you rate the overall services you and/or your loved one received from Little City Foundation?

Excellent	Good	Fair	Poor	Please explain your rating.

My loved one and family were treated with respect and dignity by Little City Foundation?

Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Please explain your response.

Did Little City Foundation provide the level of service(s) you anticipated?

Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Please explain your response.

What is the reason(s) for your decision to choose a provider other than Little City Foundation?

Do you have any comments, advice or suggestions that could help us improve our services?