GJR in PA: Youth Programs Feedback

Your voice helps shape the services we provide. This feedback form is a space to share what is working well and where we can improve in our youth programs across George Junior Republic in Pennsylvania. Your input supports continuous growth, strengthens our approach, and helps us create the best possible experience for the young people and families we serve. Thank you for taking a few minutes to help us learn and improve.

Name *

First

Last

Email *

Please indicate which Program(s) and service('s) you or your child received or participated in. *

Diagnostic
General Residential
Inpatient Non-Hospital Drug and Alcohol Rehabilitation
Intensive Supervision
Special Needs
Residential Treatment Facility (RTF)
Therapeutic Residence for Adolescent Complex Cases – Residential Treatment Facility (TRACC – RTF)
Secure
Balanced and Restorative Justice (BARJ)

How likely are you to recommend GJR to someone who may benefit from our programming and services? *

Very likely
Likely
Unsure
Unlikely
Very unlikely

recommend this you

What impact did the program have for you or your family? *

Significant positive impact
Some positive impact
No change
Negative impact
Not sure

When you had a question or concern, how responsive was staff? *

Very responsive
Responsive
Neutral
Not very responsive
Not responsive

I felt supported throughout my experience. *

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

Please provide a detailed description of your experience with this program or service. *

What was the most helpful part of your experience? What could we do better? Is there anything you wish you had known earlier? Please share any additional comments, concerns, or suggestions.

Permission to Share Your Feedback (Optional). May we use your written feedback (quotes or excerpts) in GJR marketing materials, such as social media, newsletters, print pieces, fundraising materials, or our website? *

Yes, you may use my feedback with my name
Yes, you may use my feedback with my name and photo
Yes, you may use my feedback without my name (anonymous)
No, please do not use my feedback for marketing purposes

If you would like your photo to appear with your feedback on marketing materials please upload relevant images.

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