Republic of the Philippines Department of Agriculture Agricultural Training Institute

CLIENT SATISFACTION MEASUREMENT (CSM) FORM

HELP US SERVE YOU BETTER!

This Client Satisfaction Measurement (CSM) tracks the customer experience of government offices. Your feedback on recently concluded transaction will help this office provide a better service. Personal information shared will be kept confidential and you have the option not to answer this form. By answering this form, you are agreeing that the information will be used by the Agricultural Training Institute (ATI) in planning and improvement of its program/project/service implementation.

Thank you very much.

Please complete all applicable questions.

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I. Client Information (optional)

Client Type

Citizen Business Government Employee (Employee or another agency)

Registration ID No. (RSBSRA/FEEDS/NCRFS), if any

Registered Group Name

For group beneficiaries only

Additional Group Information

Women members are less than or equal to 50% Women members are more than 50%

Name (Recipient / Group Representative)*

First Name

Middle Name

Last Name

Extension

Address*

Region

Province

City/Municipality

Barangay

Street/Purok

Gender*

Male Female Prefer not to say

Age*

Contact Number*

Email Address

Beneficiary Type*

Other (specify)

II. Intervention / Service Availed

Farm and Business Advisory Services (FBAS)

Farm/Agri-Enterprise Mgt/Production Technologies Accreditation of Extension Service Providers (ESPs) / Learning Site for Agriculture (LSA) Certification Provision of Extension Grants Scholarship Programs Training Programs

Other (specify)

Other Services

e-Learning Dormitory and Training Services Library Services and IEC Materials Training/Meeting(s) attended

Other (specify)

Details of Intervention / Service Availed*

Office and Name of Assisting Personnel*

III. Citizen's Charter*

Check your answer to the Citizen's Charter (CC) questions. The Citizen's Charter is an official document that reflects the services of a government agency/office including its requirements, fees, and processing times among others.

CC1: Which of the following best describes your awareness of a CC?*

I know what a CC is and I saw this office's CC. I know what a CC is but I did NOT see this office's CC. I learned of the CC only when I saw this office's CC. I do not know what a CC is and I did not see one in this office.

CC2: If aware of CC (answered 1-3 in CC1), would you say that the CC of this office was...?*

Easy to see Somewhat easy to see Difficult to see Not visible at all N/A

CC3: If aware of CC (answered 1-3 in CC1), how much did the CC help you in your transaction?*

Helped very much Somewhat helped Did not help N/A

IV. Client Satisfaction Measurement (CSM)*

Please select the option that best corresponds to your answer (if applicable).

Overall*

I am satisfied with the service/intervention that I received from ATI.*