Cultural Competency Client and Community Survey
Cultural Competency is defined as “a set of behaviors, attributes and policies
enabling an organization (or individual) to work effectively in cross cultural
situations.”
In assessing cultural competency, each organization (or individual) is somewhere on the
continuum moving toward greater cultural competence. There is no “right” or “wrong”.
The purpose of this survey is to establish and maintain cultural competence.
Your survey is private and we will use the surveys to form a picture of this agency’s
cultural competence.
Please answer the assessment in a manner that reflects how you see Southwest Youth
& Family Services today; not how it used to be or how it will be.
This cultural competency survey asks you to circle a number to rate behaviors you have
experienced in this organization. The rating scale is shown below and on the next page.
1
Never
2
3
Sometimes
Often
4
Always
In addition, there is space to write any comments that would help us to understand the
rating you selected.
Please complete the following:
Your Culture / Ethnicity __________________________________________
Developed by Minority Executive Directors Coalition and Achievement Architects North, 2004
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1
Never
2
3
Sometimes
Often
4
Always
Questions
For each question, circle the number that applies to your rating.
Please add any comments that will help us understand your
rating.
Rating
1. When I visit this agency or meet with an agency staff person, I feel
I am treated with respect.
Comments:
1 2 3 4 N/A
2. Individuals and families are encouraged to decide what services
they need.
Comments:
1 2 3 4 N/A
3. When I talk to others similar to me (race, gender, age, physical
abilities, etc.) they tell me they had a positive experience with this
agency.
Comments:
1 2 3 4 N/A
4. I am made to feel welcome and comfortable when I interact with
members of this agency?
Comments:
1 2 3 4 N/A
5. I see my culture / ethnicity reflected in the written materials and in
the environment of this agency.
Comments:
1 2 3 4 N/A
6. I feel this agency’s programs meet my needs.
Comments:
1 2 3 4 N/A
7. Members of this agency understand and affirm my culture/ethnicity.
Comments:
1 2 3 4 N/A
Developed by Minority Executive Directors Coalition and Achievement Architects North, 2004
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1
Never
2
3
Sometimes
Often
4
Always
8. I am able to easily read and understand written materials given to
me by members of this agency.
Comments:
1 2 3 4 N/A
9. When I talk to members of this agency, I feel I am listened to and
understood.
Comments:
1 2 3 4 N/A
10. When I interact with members of this agency, I see people who
look like me.
Comments:
1 2 3 4 N/A
11. In what ways did this agency take steps to appreciate your culture, communications
style, language, needs and expectations?
12. What did this agency do to make you feel valued and respected?
13. Any other comments or experiences you would like to share?
Developed by Minority Executive Directors Coalition and Achievement Architects North, 2004
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