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First Name:  
Last Name:
Address:
City:
State:
Zip:
Email Address :
Phone #:

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Description of Customer Service Received:
Date of Contact :
Time of Contact :
Location: Select One Main Campus - Ark City Southside (Wichita) Mulvane Winfield Other .................................................................
Department: Select One Admissions Allied HealthAthletics Bookstore Campus Security Campus Tours Career Center Computer Services Distance Learning Enrollment Financial Aid Health Services Housing Office Humanities Industrial Technology Instructional Matters Intramurals/Recreation Library Natural Science Placement Testing President's Office Scholarships Social Science Student Billing Student Life Counseling Transcripts/Registrar V.A. Benefits Vice President/Student Affairs Volunteer Office Wellness Center Unknown .................................................................
Name of Employee
that assisted you:
Describe the
service you
received: Please rate the following factors by selecting the appropriate box:
Very Satisfied
Satisfied
Unsatisfied
Very Unsatisfied

Employee Assistance  
 
 
 

Employee
Friendliness/Attitude  
 
 
 

Employee Knowledge  
 
 
 

Employee's Ability to Communicate  
 
 
 

Employee Professionalism  
 
 
 

Timeliness of Assistance  
 
 
 

Overall Satisfaction  
 
 
 

Suggestions/Comments:    

Thank you for your input. Your satisfaction is important to us.
We are committed to continually improving our customer service process.