| 1. | Sex: | |
| 2. | Class rank: | |
| 3. | Residence: | |
| 4. | Age: | |
| 5. | How did you hear about the Counseling and Testing Center: | |
| 6. | Were you required to attend counseling? | |
| 7. | Approximately how many counseling sessions have you had here? | |
| 8. | If you have decided to discontinue couseling. | |
| 9. | I found the waiting room: | |
| 10. | I got the time I wanted. |
| 11. | I got the counselor I wanted. |
| 12. | The person who answered the telephone, or made my appointment was helpful, friendly, and professional. |
| 13. | After my appointment was made, I knew the time, date, and counselor's name. |
| 14. | When I arrived for my appointment, the clerical staff was courteous and helpful. |
| 15. | My counselor was on time for my appointment. |
| 16. | My counselor seemed courteous and interested in me as a person |
| 17. | My counselor spent sufficient time with me to determine my reason for coming. |
| 18. | I knew after I left the initial appointment what my next steps would be. |
| 19. | The staff was helpful in scheduling future appointments. |
| 20. | I would rate the quality of services I received as excellent. |
| 21. | I got the kind of service I wanted. |
| 22. | If a friend were in need of similar services I wouldrefere him/her here. |
| 23. | The services I received helped me deal effectively with my problem. |
| 24. | If I were to seek help again, I would come back to your program. |
| 25. | The Counseling and Testing Center is in a convenient location. |
| 26. | The person with whom I worked with really understood my problem and how I felt. |
| 27. | The services I received here helped me stay in school. |