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
- Select All
- Victim Advocacy
- Counseling Services
- Interim Measures (housing, academics, etc.)
- Pastoral Care
- Title IX
- Support Group
Please check off all college services received:
How did you find out about these services (i.e. Hornet Hive emails, website, friends, presentations, etc.)?

Using the scale below, please circle the number that best fits your opinion for each statement: *

	Strongly disagree	Disagree	Neutral	Agree	Strongly 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.

Did you receive any referrals to other organizations? * Required
To the best of your knowledge, how many referrals did you use?
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
- An increase in level of victimization
- The same level of victimization
- A decrease in the level of victimization
- No victimization
- Not applicable
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
- Understanding issues of Gender-Based Violence
- Safety ideas/strategies
- Support for Title IX or legal processes
- Housing
- Transportation
- Referrals to other agencies/organizations/services
- Academic accommodations
- Health care for myself and/or child(ren)
- Discussion of options (i.e. reporting to Title IX or local authorities)
- Financial assistance
- Toiletries
- Getting increased social support
- Emotional Support
Overall, my experiences with the college services have been: * Required
Are there any ways that we could better meet your needs?
Is there anything else you would like to say about your experiences with college services?