Name

First Name

Last Name

Phone

(###)

###

####

Which program(s) did you participate in? (Please check all that apply) *

Community Support (Food Pantry/Back to School/Christmas)

Community Engagement (Garden/Yanma m Gama/Mumung/Decide to Dance/Sing Group)

DFV Support Services Women's Centre

WDVCAS Support Services (Case Management/Hearing Support/SAM/General Support)

FASS Support Services

DFV Educational Programs (Positive Relationships/Me; Beyond DV)

Youth focused support services

Community Event

Community Learning Event

Other (Please Specify):

I am satisfied with my experience of Women Illawarra (Please rate each aspect on the following scale): *

Program Quality

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Staff Support

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Accessibility

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Overall Experience

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

How have our programs impacted you or your community? (Please check all that apply) *

Improved access to resources

Enhanced well-being

Improved Safety

Improved knowledge and/or confidence

Increased community participation

Other (Please specify):

Would you like to be contacted for further feedback or involvement?

If you wish to be contacted, please ensure that you have entered your name, phone number and email address at the top of this form.

Yes

No