Student Name:

Student E-mail:

Student Phone Number:

Date of your appointment:


Name of the person with whom you had an appointment:
Not Sure Josie Adams James Bender Minnie Burton Yvonne Creamer Pam Davis Curlada Eure-Harris Monica DelCastillo Lisa Haston Gil Hill Kim Kory Sharon Letson Felipe Lopez Tom Paine Craig Prether Louise Rabidoux Doris Roberson Jennifer Spenny Kris Stairs Janet Tower

Please rate your experience with us:

It was easy to schedule an appointment.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

I was scheduled to meet with the "appropriate" staff/program.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

I was greeted and checked in promptly for my appointment.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

The service provider was responsive to my needs/concerns.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

The provider answered all my questions, or referred me to someone who could.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

My needs/concerns were addressed in a respectful and considerate manner.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

My opinion of the overall experience with the Support Services Dept.
Very Satisfied     Satisfied   Somewhat Satisfied  Not Satisfied

Additional Comments: