Name of Company:
Mailing Address of Company:
Name of Person Surveyed:
Email Address of Person Surveyed:
Date Survey Was Completed:
How Was Survey Completed? (Online, Face to Face, Phone)
1) How would you rate your experience with Supported Employment?
Excellent
Good
Fair
Poor
Why? (please specify)
2) How would you rate your experience working with Stand Up?
Excellent
Good
Fair
Poor
Why? (please specify)
3) How effectively did Stand Up, Inc. staff explain the services we provide?
(i.e. Levels of support that can be expected, length of time that support will be given, fading process etc.)
Very Effectively
Effectively
Ineffectively
Very Ineffectively
Comments: (optional)
4) How would you rate the job done by Stand Up Job Coaches?
Excellent
Good
Fair
Poor
How could we improve? (please specify)
5) Were you satisfied that adequate training and support was given to your new employee when they started working for your company?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Comments: (Optional)
6) Are you satisfied that adequate support is currently being given to your employee(s) to do the job you hired them to do?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Comments: (optional)
7) Do you know how to get in touch with your employee's Job Coach should an issue arise?
Yes
No
Comments: (optional)
8) Would you consider hiring another person with a disability should you need to fill a position?
Yes
No
Why? (optional)
9) Would you give Stand Up, Inc. an opportunity to help you fill a future job opening you may have?
Yes
No
If No... Why?
10) Would you allow Stand Up to conduct Assessments at your business to assess job seekers skills and abilities?
Yes
No
Maybe
Comments: (optional)
11) Would you recommend Stand Up, Inc. to other business owners?
Yes
No
If No... Why?
12) Would you like more information from Stand Up, Inc. regarding: (check all that apply)
Work Opportunity Tax Credits
Reasonable Accommodations
Contact Information for Stand Up, Inc. Leadership
Disability Awareness Education
Cultural Awareness or Diversity
No Information Needed
Enter any additional comments you may have about Stand Up, Inc Services: (Optional)
If you selected "Cultural Awareness or Diversity" in question 12 above please specify below the areas of your interest... age, gender, culture, sexual orientation, spiritual beliefs, social economic status, language
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