Feedback form

This is an anonymous questionnaire. Please do not include your name.


College services are any assistance received through college resources (i.e. counseling, advocacy, pastoral care, etc.). We value your feedback and ask that you answer as honestly as you can. By completing this form, you give us permission to use the information to evaluate our program and improve our services. All information that you provide will be kept confidential and anonymous and will in no way affect your ability to receive services in the future. Thank you in advance for taking the time to answer these questions.

To remain confidential, any questions regarding this survey can be directed towards the personnel you worked with or you can contact Haley Mangette, haley.mangette@kzoo.edu

  • I have received the following services: * Required
    Please check off all college services received:
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
    Since I contacted college services, I feel stronger emotionally.
    I feel like I can reach out to services again.
    I have increased knowledge about sexual violence (i.e. tactics used by people who are abusive, consent, etc.)
    Because of support from college services, I have an increased knowledge of my options and/or community resources.
  • Since I started receiving services through the College, I have experienced (check one): Victimization is to be made a victim of an unwanted sexual contact, abusive relationship behaviors, etc. * Required
  • What information/referrals/services did you receive from college services? (Depending on the individual you saw, they may not be able to provide direct access to all these services.) Check all apply. * Required