St. Vincents Survey Form Examples

Currently a demo as a proof of concept.

Table of Contents

Self-Sufficiency Matrix

This form below is hosted by Google Forms, based off an adaption of the Arizona Self-Sufficiency Matrix published by LifeWorks from Austin, TX. It is intended to be filled out by professionals/volunteers (not clients), and includes diagrams to determine client’s current degree of self-sufficiency.

Using an adapted version of a self-sufficiency matrix has a few advantages:

1. It’s a validated tool with plenty of documentation available online. This is incredibly helpful for folks like me (who have zero social work training) because there are all sorts of guides on how to answer questions
2. It appears to be widely used across many organizations, which means we aren’t re-inventing the wheel
3. The outcomes are clear and can be easily reported. This seems especially important for grants
4. Items can be added or removed from the survey as needed

Need someone conversational in Spanish in the pantry

As this is a demo, you can submit the form to test it out, and the results are shown below. I only have a few sections for this demo, but it could easily be expanded to include more items from the matrix.

Responses to above

REDCap form

The other option would be to make our own novel instrument that could be filled out by clients directly. An example of such using UTMB’s access to the REDCap software is here.

https://redcap.utmb.edu/surveys/?s=KKN8TTKXHM