(name of office deleted for obvious reasons)
Protester Satisfaction Survey
(standard form #27B/j)
Please take a few minutes to fill out this questionaire. All answers will
be kept confidental and are used only for research purposes.
1: How did you hear about us? ____________________________________________
2: Did you enjoy your overall experience today? __ Yes __ No
If not, why not? _____________________________________________________
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3: Is this your first protest with this (office)? __ Yes __ No
4: On a scale of 1 to 10, please rate the following aspects of our service:
(circle one)
Representative accessibility 1 2 3 4 5 6 7 8 9 10
Employee politeness/patience 1 2 3 4 5 6 7 8 9 10
Toilet availability 1 2 3 4 5 6 7 8 9 10
Snacks 1 2 3 4 5 6 7 8 9 10
Parking 1 2 3 4 5 6 7 8 9 10
5: Would you come back and protest again? __ Yes __ No
6: What can we do to make future protests more fulfilling? _______________
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Thank you for your time. Your answers will help (this office) become more
responsive to protester needs as part of our service goals.
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