Post Appointment Survey

Please complete this survey as best you can. Your honest responses help improve our programs and get funding. We will never share your personal information.

FIRST NAME

LAST NAME

EMAIL ADDRESS

DATE OF BIRTH

Please format in the following way: MM/DD/YYYY Don't know the date of birth? Use 02/22/2022 as a placeholder

Location of Appointment

Date of Appointment

Staff Use Only please continue with next question

Not able to fill out survey

Reason for NOT completing survey

Was the person who assisted you today helpful?

If you'd like to comment about your dressing assistant, please do so here:

Do you feel more confident after your appointment today?

Do you feel more able to make a positive first impression with the clothing and support you received today?

What was the main reason for your appointment today?

What is your current employment status?

What are your goals for the next 1-3 months? (hold the Ctrl key to choose all that apply or select None of These)

Reflecting on your visit today, how important were the following things?

	Very important	Somewhat important	Not important
Clothing to wear for a job search or work
Clothing to wear everyday
Clothing in my size
Clothing aligned to my gender identity
Clothing that is high quality
Clothing that is stylish/in style
Having clothing I couldn't otherwise afford
Easing financial burden on my family
Ease of receiving assistance
Being treated fairly and with respect
Having enough time to shop and try things on
Knowing I can come back for additional clothing throughout the year
Ability to do something good for myself (engage in self care)

Please tell us a little about yourself. If you have been here before, some information may have been prefilled for you to review. None of your personal information will be shared.

What is your race?

What is the highest level of education you have completed?

What is your gender?

Are you currently receiving any of the following types of public assistance?

Information will NOT be shared with agencies. Please select all that apply.*

Do any of the following apply to you? Please select all that apply. We are asking this question in order to better serve our participants. All answers will be kept confidential and not shared with outside organizations.

I have served time in jail or been on probationI am a refugee or immigrantI am lesbian, gay, or bisexual (LGBQA+)I am transgender or intersexI have a disabilityEnglish is not my first languageI am the primary caregiver for children under age 18I have served in the US Armed Forces, Military Reserves, or National GuardI am homeless or have experienced homelessness

If you have additional questions or feedback for us, please leave a brief message:

Contact SFID from Lookup

Appointment SFID Prefill

Retired Questions

I know more about how to introduce myself in a professional way (such as shaking someone's hand and making eye contact).(Removed 10.2023)

AgreeDisagreeNeither agree nor disagree

I know more about why it's important to show up to an interview on time (neither to late nor too early).(Removed 10.2023)

AgreeDisagreeNeither agree nor disagree

Please provide your First Name, Last Name and Date of Birth before clicking "Submit"

Contact Information

Good wages	Flexible schedule
Fixed, dependent schedule	Feeling fulfilled in my career
Full-time work	Part-time work
Shorter commute	Access to benefits like healthcare, 401k, tuition reimbursement, etc.
Using my training/education in my work	Room for advancement
Starting/expanding my own business	Flexible gig work (Lyft/Uber, catering jobs, day laborer, bike messenger, etc.)
Other

Cash assistance/TANF	Child Care Assistance (CCIS)
Food Stamps/SNAP	Health Benefits (CHIP, Medicaid, Pace, or Medicare)
Disability/SSI	Unemployment Compensation
Housing Assistance	I am not currently receiving public assistance