Form SBA Form 1419 SBA Form 1419 SBA COUNSELING EVALUATION

OMB Approval No.: 3245-0183
Expiration Date: 9/30/2006

SBA COUNSELING EVALUATION
Resource Partner I.D.
CLIENT I.D.

Dear Counseling Client:
Your response to this evaluation form is extremely important to us; its purpose is to help us make our resource partner counseling
services as meaningful and as beneficial as possible.
Please mark (X) the best response to the following questions.
1.

How did you hear about Small Business Administration (SBA) counseling services? (Check all that apply.)
Telephone Book

Chamber of Commerce

Brochure

Friend

Newspaper

SBA

Financial Institution

Other

(Please mark one answer per question)
2.

Did the assistance you received help you make the decision wheher or not to go into business?
Yes

3.

Yes

Unsure

Yes

Unsure

Yes

Unsure

Thinking about the assistance that you did receive, do you believe that you could have more readily obtained
the same assistance from another source at an affordable price?
Yes

9.

Unsure

In your opinion did the counselor/consultant possess the necessary skills to proivde the assistance needed?
Yes

8.

Yes

Did you receive specfic recommendation(s) from the counselor?
Yes

7.

Unsure

Did the counselor/consultant point out other problem areas?
Yes

6.

Yes

Did the counselor/consultant respond to your needs?
Yes

5.

Already in business

Did your request for assistance receive prompt attention?
Yes

4.

Yes

Yes

Unsure

Do you anticipate a need for additional assistance from the counselor/consultant in the furture?
Yes

Yes

Unsure

SBA Form 1419 (8-06) Previous Edition Obsolete
This form was electronically produced by Elite Federal Forms, Inc.

10. Would you recommend the counselor/consultant to others?
Yes

No

Unsure

11. As a result of the assistance you received have you changed any of your current management practices/strategies?
If yes, please mark all that apply
Financial Management

Human Resources Management (hiring/firing)

Marketing Strategy

International Trade

Obtaining Capital

Promotional Strategy

General Management

Other

"If no, please mark all that apply"
Too early to determine

Would take to long to implement

Cost to much

Other
12. Please indicate the value of the information you received from the counselor/consultant:

Extremely Valuable

Valuable

No Opinion

Somewhat Valuable

Not Valuable

1. Usefulness of information

5

4

3

2

1

2. Relevancy of the information

5

4

3

2

1

3. Timelines of the information

5

4

3

2

1

13. Please indicate how effective the counselor/consultant was in assisting you:
Extremely Valuable

Valuable

No Opinion

Somewhat Valuable

Not Valuable

1. Assistance met my needs

5

4

3

2

1

2. Counselor's ability to assist me

5

4

3

2

1

3. Counselor was friendly

5

4

3

2

1

4. Counselor was current on

5

4

3

2

1

5

4

3

2

1

management issues
5. Counselor was knowledgeable

PLEASE NOTE: The estimated burden for completing this form is 10 minutes per response. You will not required to respond to this
information collection if a valid OMB approval number is not displayed. If you have questions or comments concerning this estimate
or other aspects of this information collection, please contact The U.S. Small Business Administration, Chief, Administrative Information
Branch, Washington, D.C. 20416 and/or Office of Management and Budget, Clearance Officer, Paperwork Reducation Project
(3245-0183), Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.