Step 1 of 2 50% NameThis field is for validation purposes and should be left unchanged.Enter your first and last name:*Please add your email address:* By completing this survey, you may be entered into a drawing to win one of two $25 gift cards. Drawings are held for 2 winners, 4 times per year. (January, May, September and December.) Winners receive the gift card in the mail. Please choose from the options below:Drawing preference: Yes, please enter me into the drawing. No, do not enter me into the drawing. Gift card preference: Target Amazon.com Walmart Part 1: Tell us how we are doing?We want to know how we can improve our services to you. Your feedback is welcome at any time.1. On a scale of 1 to 10, please rate your overall experience with ERI: 10 = Very Satisfied and 1 = Not SatisfiedVery Satisfied - 109876Satisfied - 5432Not Satisfied - 1 2. On a scale of 1 to 10, rate the information / assistance you have received from ERI: 10 = Very Satisfied and 1 = Not SatisfiedVery Satisfied - 109876Satisfied - 5432Not Satisfied - 1 3. What has been most helpful about the services you have received from ERI?4. What would improve our services? 5. As a result of working with ERI, I feel more confident in pursing my employment goals. Yes No 6. As a result of working with ERI, I feel more confident about my financial situation. Yes No 7. As a result of working with ERI, I am confident about access to health care. Yes No 8. Would you recommend ERI to a friend? Yes No Additional Comments or Suggestions: Part 2: Tell us how you are doing?We want to know how things are going for you. These questions will help us better respond to your healthcare, employment and benefit concerns. 9. Have any of the following changes occurred in your life since we last talked to you?Choose all that apply: You started or stopped working You had a change in pay You had a change in hours You have a new employer Your address or contact information has changed Your family situation has changed No changes Other? What is your new contact information (address, telephone, etc.)Other Changes:10. What is your current employment situation? I am working. I am not working. 10a. Tell us a little bit more... I am not considering work at this time I am considering work but am not sure how to get started I'm preparing to for work by attending training, interning, or other preparation activity I am actively looking for work by applying for jobs 10b. Tell us a little bit more... I am happy in my current job and want to maintain my employment I am considering a change in my job - advancing, more hours, different job, etc. I am preparing to advance in my job by attending training or other preparation activity I am actively seeking to get a new job, start a new career, increase my work hours, etc. 11. What if anything is keeping you from working to your full potential?Choose all that apply: Fear of losing cash benefits Fear of losing access to cash benefits if the job doesn't work out Health issues Lack of skills / training Transportation Need for assistive technology Fear of losing healthcare Criminal history Lack of housing Finding a job / employment opportunities Other? Please describe other:12. When it comes to your benefits, what are your goals?Choose all that apply: I need help getting public benefits I'm looking for help with understanding work and benefits I need help with solving a benefit problem such as an overpayment I would like someone to check in with me from time-to-time about my benefits 13. When it comes to your healthcare, which of the following pertains to you?Choose the option that best fits your current situation. I want to get healthcare coverage I want to maintain my healthcare coverage I want better healthcare coverage 14. Often times financial stability, benefits, and employment goals go hand in hand. ERI is committed to helping our customers achieve their financial goals. With that in mind, are you interested in free financial counseling services? Example: debt questions, housing foreclosure prevention, home buyer assistance, mortgage counseling, student services, financial education, etc.Choose the option that best fits your current situation. No. I am not interested in improving my finances through free financial counseling. Yes. I am interested in improving my finances through free financial counseling services. I am currently receiving financial counseling services! 15. Do you have any benefit, healthcare, or employment-related questions for us?Thank you for your comments and feedback.
