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Survivor Voice: Experience Survey

Date:

This survey is for people who got support from a sexual assault support center in Maine. The information you share here will help us to make sure that we are always improving our services. Your name is not attached to your survey results and your information will not be shared without your consent. Thank you for taking the time to share your voice and experience with us.

Service Impact and Quality

The following set of statements asks you to reflect on your experience with the services you received from a sexual assault support center.


Please rate the following statements with 1 being strongly disagree and 5 being strongly agree. If the statement does not relate to an experience you had, please choose N/A for not applicable.

😞
1=Strongly Disagree
🙁
😐
3=Neutral
🙂
😀
5=Strongly Agree
⦸
N/A

When I was receiving support from a sexual assault support center:

Advocates respected my identity and background:
1
2
3
4
5
N/A
The times I was offered services worked for me:
1
2
3
4
5
N/A
The place of the services worked for me:
1
2
3
4
5
N/A
I was given options about what kind of services I received:
1
2
3
4
5
N/A
My choices were respected:
1
2
3
4
5
N/A
Were there services that you wished were offered to you that weren't? If so, what services?

Because of the support I received:

I know more about how to meet my needs:
1
2
3
4
5
N/A
I have more options to plan for my safety:
1
2
3
4
5
N/A
I am more informed about systems like police, court, hospitals, or schools:
1
2
3
4
5
N/A
I am better able to work through brain and body experiences (like anxiety, depression, fear, etc.):
1
2
3
4
5
N/A
I am better able to ask for the things I need:
1
2
3
4
5
N/A
What was the most helpful part of the services?
What could advocates have done differently to improve your experience with these services?
On a scale of 1-5 stars please rate your overall satisfaction:
1 Star
2 Stars
3 Stars
4 Stars
5 Stars

More about you

What services did you get from the center? Check all that apply:





Please describe the other services you got:
Are you okay with us using what you wrote to share information about our services? All information would be anonymous:
Race:
--Select Option(s)--
Race: Other Defined:
Ethnicity:
--Select Option(s)--
Ethnicity: Other Specified:
Gender:
--Select Option(s)--
Gender: Other Defined:
Please check all that apply to you:





Are there any other identities you hold that you want us to know about? If so, please list: