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  5. Human Services Website
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Hello:
You are invited to participate in our survey Proposed Human Services Website. In this survey, approximately 100 people will be asked to complete a survey that asks questions about the likely hood of use of a website that contains profiles of various human services that can be found by the general public. It will take approximately 3 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Kelly Rayes at 734-272-5892 or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
Would your agency be interested in being featured on a website that would list your agency's information in an easy to read profile format?
 
Yes
 
No
 
Maybe
 
Other
 
 
 
 
What would you like to see on your agencies profile (Select all that apply)?
 
Your Agency Name
 
Agency Logo
 
Your Agency Address
 
Your Agency Phone Number
 
Your Agency Fax Number
 
Your Agencies Website
 
Your Agency Hours of Operation
 
Your Agency Intake Hours
 
Your Agency Facebook and Twitter Links
 
A List of Services your Agency’s Services
 
An “About Us” Section to inform your Clients/Customers about your Agency
 
An “Eligibility” Section to inform your Clients/Customers regarding their eligibility to your agencies services
 
A Section to List the Counties your Agency Serves
 
Ability to upload Applications, and/or forms for Clients/Customers
 
A Map with directions to your Agency
 
Other
 

 
 
 
Do you think a website with detailed agency information would be helpful to potential clients/customers?
 
Yes
 
No Maybe
 
Other
 
 
 
 
Would your agency be be interested in setting up a profile on this website?
 
Yes
 
No
 
Maybe
 
Other
 
 
 
 
How much would you be willing to pay monthly to have a profile on this website(Select all that apply)?
 
$8/mo
 
$10/mo
 
$15/mo
 
$20/mo
 
Other
 

 
 
 
How soon would your agency like to use a website like this?
 
Today
 
This Week
 
This Month
 
Within 3-6 Months
 
Within a Year
 
Never
 
Other
 
 
 
 
If you are not interested in using a website like this, could you please explain why?
   
 
 
If you are interested in more information about this website, please fill out the contact information below.
First Name : 
Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
Email Address : 
 
 
 
Comments/Suggestions: