Form ETA 9124A ETA 9124A Participant Survey

SCSEP Participant
Customer Satisfaction Survey

OMB Approval Number: 1205-0040
Expiration Date: ##/##/20##

OLDER WORKER CUSTOMERS
The Older Worker Program, also known as the Senior Community Service Employment Program
(SCSEP) or Title V of the Older Americans Act, wants to provide the highest quality services to its
customers, even in the midst of the COVID-19 pandemic. You can help us improve our services by
answering the following questions. Please base your answers on your entire SCSEP experience with this
grantee unless directed otherwise in a particular question.
Please be frank in your responses. Your answers will be kept private to the extent permitted by law and
will be used for program evaluation and improvement purposes only. No one in the agency will see your
individual responses.
Please fill in your response to each answer like this:

, NOT this

Choose the number on the scale below each question that best represents your opinion. The last two
questions allow you to express your ideas about the program in your own words. Thank you in advance
for your help.
1. Utilizing the scale below, what is your overall satisfaction with the services provided by the Older
Worker Program/SCSEP? (Choose one number)
Very
dissatisfied

1

2

3

4

5

6

7

8

9

Very
satisfied

Didn't
receive

10

90

2. Considering all of the expectations you may have had about the services of the Older Worker
Program/SCSEP, to what extent have the services met your expectations? (Choose one number)
Fall
short

1

2

3

4

5

6

7

8

9

Exceed

Didn't
receive

10

90

3. Now, think about the ideal services for people in your circumstances. How well do you think the
services you received compare with the ideal services? (Choose one number)
Not at all
close

1

2

3

4

5

6

7

8

9

Very
close

Didn't
receive

10

90

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
Completion of this survey is completely voluntary, and information collected will be kept private to the extent permitted by law and used for program
evaluation purposes only. Thank you for your participation. If you have any comments regarding this estimate or any other aspect of this survey, including
suggestions for reducing this burden; please send them to the U.S. Department of Labor, Office of Workforce Investment, Room C-4510, 200 Constitution
Avenue, NW, Washington, DC 20210. (Please do not return surveys to this address.)

Please continue on other side

ETA-9124A
(Rev 1/15/2023)

SCSEP Participant Customer Satisfaction Survey
4. The primary reason(s) I enrolled in the Older Worker Program/SCSEP were to: (Choose all
that apply)
o Obtain a full-time job after completing the program
o Obtain a part-time job after completing the program
o Participate in the program’s training and host agency
activities
o Provide service to my community

o Meet new people
o Increase my income
o Feel more useful and independent

o Other ____________________________________

5. At the time I enrolled, the Older Worker Program/SCSEP staff told me what I needed to know
about how the program worked and what to expect. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

6. The Older Worker Program/SCSEP staff gave me a host agency assignment that matched my
employment interests and needs. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

7. The Older Worker Program/SCSEP helped me obtain the supportive services, such as assistance
with transportation, housing, or medical care, that I needed to meet my employment goals.
(Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Didn’t need
any

10

90

8. Given your transportation situation, was your host agency assignment convenient to where you
live? (Choose one answer)
Yes

Don’t know

No

9. There is someone in the Older Worker Program/SCSEP I can talk to when I need to. (Choose one
number)
Strongly
disagree

Strongly
agree

Doesn’t
apply

1
2
3
4
5
6
7
8
9
10
90
10. During my community service assignment, my host agency gave me the training I needed to be
successful in my assignment. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Didn’t need
any

10

90

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SCSEP Participant Customer Satisfaction Survey
11. I had a say in the types of skills I would gain during my host agency assignment. (Choose
one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

12. Which of the following best describes your experience with computer training? (Choose
one number)
o

I received the computer training I needed

o

o

I received computer training, but it didn’t
meet my needs
I needed computer training, but little or none
was offered

o

o

I didn’t need computer training but was given
the training anyway
I didn’t need computer training and didn’t
receive any

13. I feel comfortable at my host agency assignment. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

14. Compared to the time before you started working with the Older Worker Program/SCSEP,
would you say your physical health is better, worse, or about the same? (Choose one number)
1
Better

2
Worse

3
About the same

9
Don’t know

15. Compared to the time before you started working with the Older Worker Program/SCSEP,
how would you rate your outlook on life? (Choose one number)
1
Much more
negative

2
A little more
negative

3
About the same

4
A little more
positive

5
Much more
positive

9
Don’t know

16. The income I receive from the Older Worker Program/SCSEP is important for meeting my
basic expenses. (Choose one number)
Strongly
disagree

1

2

3

4

5

6

7

8

9

Strongly
agree

Don’t
know

10

90

17. During my host agency assignment, the Older Worker Program/SCSEP staff pressured me to
leave my host agency assignment for a job before I was ready. (Choose one answer)
Yes

No

Doesn’t apply

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SCSEP Participant Customer Satisfaction Survey
18. Overall, how helpful has the Older Worker Program/SCSEP been in preparing you for
success in the workforce? (Choose one number)
Not at all
helpful
1
2

3

4

5

6

7

8

Extremely
helpful
9
10

Don’t
know
90

If you have left the Older Worker Program/SCSEP and have a job, answer Questions 1920, and continue with the rest of the survey. If you do not have a job, skip to Question 21.
19. How much help did Older Worker Program/SCSEP staff give you in finding employment?
(Choose one number)
No
help
1

2

3

4

5

6

7

8

A great deal
of help
9
10

Don’t
know
90

20. Do you feel that your participation in the Older Worker Program/SCSEP prepared you for
employment in these organizations? (Choose all statements that apply)
o I felt prepared for employment in a nonprofit
organization
o I felt prepared for employment in a government
organization

o I felt prepared for employment in a for-profit
business
o I did not feel prepared for employment in any
organization or business

21. How has the COVID-19 pandemic affected you as a SCSEP participant? (Choose all that
applied at any time in the past year)
o I was not allowed to go to my assigned host agency
o I refused to go to my assignment because I was
afraid I would get sick
o I went to my host agency, but I was worried about
getting sick when traveling to and from the
assignment or working at my assignment
o I lost my host agency assignment and the money
associated with that assignment

o I received pay but missed the social contact I would
have had if I been able to go to my assignment
o I was not able to find unsubsidized employment
because employers are closed or not hiring
o I experienced little or no effect from the COVID-19
pandemic

22. Based on your experience, what is the most effective aspect of the Older Worker
Program/SCSEP?
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_________________________________________________________________________________________________________

23. Based on your experience, what would you recommend to make the Older Worker
Program/SCSEP more effective?
_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
___________________________________________________________________________________________________________

Thank you for taking time to complete this survey.
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