Template · Programs

Participant feedback survey

A short, plain-language feedback survey for the people your program serves: a few questions about change and experience, one open question, and a privacy note.

Three editable formats: Word (.docx), Rich Text (.rtf) and plain text (.txt). Reviewed October 21, 2026.

How to use this template

  1. Download it as a Word file (.docx), which opens in Microsoft Word, Google Docs, Pages and LibreOffice, or as Rich Text (.rtf) or plain text (.txt). All three are editable.
  2. Fill in every blank. Blanks are in square brackets, like [ORGANIZATION NAME], and are highlighted in the preview below. Delete any bracketed notes you don't need.
  3. Make it yours. Check it against your bylaws and your state's rules, and change anything that doesn't fit. Have your board approve it where it says so.
  4. Printing? Print this page: the printout leaves out the site's menus and shows the template with lines for the blanks.

Asking the people you serve what they think is one of the simplest ways to improve a program, and to show funders what difference you make. This template is a short survey you can hand out on paper, read aloud or put online. It asks a few questions about what changed and how people were treated, and ends with an open question. Our guide to measuring impact explains how to choose what to measure and how to look at the results.

How to adapt it

  • Keep it short. Choose the questions that match the outcomes in your logic model, and cut the rest. A survey people finish beats a long one they abandon.
  • Use plain words and short sentences. Test it on two or three people before you use it, and change anything they stumble over.
  • Translate it into the languages your participants read, and offer to read it aloud. Let people answer in their own language.
  • Ask the same questions each time (for example, at the start and end of a program) so you can compare.
  • Make it anonymous if you can, and say so. If you need names (for example, to follow up), say why, and keep the answers separate from contact details.
  • Never make help depend on answering. Say clearly that skipping the survey, or any question, won't affect the help people receive.

Privacy

The FTC's guide to protecting personal information sums up the approach: "Keep only what you need for your business" and "Properly dispose of what you no longer need." For a feedback survey, that means:

  • don't ask for information you won't use, such as full date of birth or address
  • avoid sensitive topics (health, immigration status, income, trauma) unless you truly need them and know how you'll protect the answers
  • keep completed surveys somewhere only the people analyzing them can see, and destroy them when you're done
  • report results as totals or anonymous quotes, never in a way that identifies someone

Our data privacy guide covers this in more detail.

Preview

Tell us what you think: [PROGRAM NAME]

Thank you for taking part in [PROGRAM NAME]. We'd like to know what's working and what we could do better. This survey takes about [NUMBER] minutes.

  • [FOR PARTICIPANTS UNDER 18: "A parent or guardian has given permission for you to take this survey, but it's still your choice."]
  • It's optional. You can skip any question. Your answers won't affect any help or service you get from us.
  • It's private. [CHOOSE ONE: "Please don't write your name." OR "We ask for your name only so we can [REASON]. We keep it separate from your answers."]
  • Only [WHO, FOR EXAMPLE "OUR PROGRAM COORDINATOR"] will see your answers. We'll share results only as totals or without names.

About the program

How much do you agree? Tick one box for each line.

Strongly agreeAgreeNot sureDisagreeStrongly disagree
I was treated with respect.[ ][ ][ ][ ][ ]
The times and place were easy for me.[ ][ ][ ][ ][ ]
I understood the information I was given.[ ][ ][ ][ ][ ]
I would recommend this program to someone I know.[ ][ ][ ][ ][ ]

What changed for you

Compared with before you started the program:

Much betterA little betterAbout the sameA little worseMuch worse
[OUTCOME 1, FOR EXAMPLE "HOW CONFIDENT I FEEL READING WITH MY CHILD"][ ][ ][ ][ ][ ]
[OUTCOME 2][ ][ ][ ][ ][ ]
[OUTCOME 3][ ][ ][ ][ ][ ]

In your own words

  1. What was the most useful part of the program for you?

[SPACE TO WRITE]

  1. What is one thing we could do better?

[SPACE TO WRITE]

  1. Is there anything else you'd like to tell us?

[SPACE TO WRITE]

Optional: about you

[ONLY INCLUDE QUESTIONS YOU WILL USE, FOR EXAMPLE:]

  • How long have you been coming to [PROGRAM NAME]? [ ] Less than 3 months [ ] 3 to 12 months [ ] More than a year
  • How did you hear about us? [SPACE TO WRITE]

Thank you. If you'd like to talk to someone about the program, contact [NAME] at [PHONE OR EMAIL].

For staff: after the survey

  • Date collected: [DATE]
  • Number handed out: [NUMBER]. Number returned: [NUMBER]
  • Where completed surveys are stored: [LOCATION]
  • Destroy by: [DATE]
  • What we'll change as a result: [NOTES]

Keep going

Sources

Checked on October 21, 2026. Rules and fees change, so follow the links for the current version.

  1. FTC: Protecting Personal Information, A Guide for Business
  2. U.S. Department of Education, Student Privacy Policy Office: What is the Protection of Pupil Rights Amendment (PPRA)?

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