Mail Survey Example

Please choose one adult member of your household to complete this questionnaire on behalf of all family or household members.

Your answers to these questions will be held in confidence and reported only in statistical summaries. Please do not give us your name and address.

If you have any questions about this survey please telephone the Library at (518) 555-0000.

Thank you for your cooperation in our efforts to plan for the future and continue to serve you to the limits of our ability.

1. How many individuals of all ages are presently living in your household? DO NOT INCLUDE ANY HOUSEHOLD MEMBERS AWAY AT SCHOOL, IN ARMED FORCES, ETC.
A. 1	B. 2	C. 3	D. 4	E. 5 or more, please specify: ___

2. Please indicate below the sex and approximate age of each member of your family and whether or not he or she has a Library card.

Adults	Sex		Age						Has a Library Card?
(Over 18)	Male	Female	18-24	25-34	35-44	45-54	55-64	64+	Yes	No
Female Head
Male Head
Other Adult
Other Adult

Children	Sex		Age				Has a Library Card?
(Under 18)	Male	Female	Under 2 yrs.	2-5	6-11	12-17	Yes	No
Child
Child
Child
Child

2a. Are any members of your household handicapped to the extent that special services are required?

A. Yes (If yes, please explain below) | B. No

2b. If "yes" in question 2a: Which member of your household is handicapped and in what way?

__________________________________________________________________________

3. In general, How often does each adult with a Library card visit the Library?
	1-2 times a week or more	2-3 times a month	Once a month	Less often	Never
Female Head
Male Head
Other Adult
Other Adult

Please answer questions 4-12 for yourself

4a. Approximately how often do you personally come to the Library to borrow each of the following:
	1-2 times a week or more	2-3 times a month	Once a month	Less often	Never
Circulating Books
Magazines/Periodicals
Videocassettes/ DVDs
Compact Discs
Recorded Books

4b. How often do you personally come to the Library to use each of the following:
	1-2 times a week or more	2-3 times a month	Once a month	Less often	Never
Parenting Information Center
Children's Room
Health Information Center
Medicare Counseling
Notary Public Service
Computerized Databases
Copy Machines
Study Desks
Telephone Books
Computer (Software &/or Internet Access)
Periodicals (Current)
Periodicals (Back Issue)
Reference
Job Information Center
Other (please specify) ________________________

4c. How often do you personally come to the Library to attend each of the following:
	1-2 times a week or more	2-3 times a month	Once a month	Less often	Never
Movies
Concerts
Art exhibits
Community meetings
Mini courses
Other programs

5. How easy is it for you to get to the Library?
A. Very easy	B. Fairly easy	C. Not too easy	D. Fairly difficult	E. Very difficult
(If you answered A or B, please skip to question 6a)		(If you answered C, D or E, please answer question 5a)
5a. If difficult or not too easy, why is it not easy for you to get to the Library? _________________________________________________________________ _________________________________________________________________

6a. How do you feel about the space or facilities now available for your use at the Library? Do you consider the available space or facilities for each of the following to be Satisfactory or Not Satisfactory?
	Satisfactory	Not Satisfactory
Art Exhibits
Meeting and program facilities for concert, films, lectures, etc.
Recordings (Audio/Video)
Children's Library
Copy Machine
Parking
Rest rooms
Quiet study space
Seating (children's room)
Seating (reading room)
Seating (Reference room)
6b. Please record below any comments you may wish to make about available space or facilities: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

7a. Do you receive the monthly Library newsletter?
A. Yes	B. No

7b. How much of the Library newsletter contents do you usually read?
A. All or most of it	B. Some of it	C. Only the calendar events	D. Nothing at all

8. How satisfied are you, overall, with the services, resources and programs provided by the Library on a scale of 1 to 5, if 1 represents not satisfied and 5 represents extremely satisfied?
Not satisfied				Extremely satisfied
1	2	3	4	5

9. Are there any additions or changes you would like to see in the services, resources or programs being provided by the Library?

_________________________________________________________________________

10. How important is the Library to you and your family on a scale of 1 to 5, if 1 represents Unimportant and 5 repesents Very Important?
Unimportant				Very important
1	2	3	4	5

11. Following is a list of various ways in which different people spend their leisure time. Which of these ways do you like very much to spend your own leisure time? (Check as few or as many as you like.) Whether or not you like them very much, which ones do you spend most of your leisure time doing? Which, if any, would you like to spend more time on?
	a. Like very much	b. Spend most time	c. Would like to spend more time
Reading a newspaper
Reading a book
Reading a magazine
Watching television (broadcast or cable)
Watching movies (in theatre or video/DVD)
Listening to radio/CD
Playing video games
Using personal computer
Going to theatre, opera, ballet or music concert
Going to art museum or gallery
Volunteer community activities
Spending time on hobby: fine art, craft, photography
Spending time on performing hobby: acting, singing, musical instrument
Socializing, visiting friends/family in their home
Socializing in a pub or restaurant
Spending time with family/ children
Traveling to distant places
Working / enjoying the outdoors
Boating/fishing
Watching sports
Exercising/ playing sports

THE FOLLOWING INFORMATION IS FOR CLASSIFICATION PURPOSES ONLY

A. What is the highest grade or year in school completed by each adult member of your family?
	Some High School or less	High School Graduate	Some College	College Graduate	Advanced Degree
Female Head
Male Head
Other Adult
Other Adult

B. Does the employed household head (or heads) work locally or outside the city/town/village?
	Works Locally	Works Outside
Female Head
Male Head

C. Which of the following villages or local communities do you live in? (If your community is not on the list, please indicate the name of the street you live on and the nearest cross street.)
Village	Check appropriate box
Pleasantdale
Brookville
Ruxton
Sandy Plain

Local Communities (in unincorporated areas)	Check appropriate box
The Estates
The Farms
The Hills
Oakwood
New Town
Northside
Parkside
Other (please specify): ____________________________________

D. Which racial or ethnic group do you belong to?
A. Asian	B. Black	C. White	D. Other (please specify) _____________________

E. Are you of Hispanic origin or decent?

A. Yes | B. No

F. What is the primary language spoken at home?

A. English | B. Other (please specify): _________________________

G. For statistical purposes, please identify yourself in terms of your family relationship, sex, age and Library membership:

Family Head
Other Adult

Male
Female

18-24		35-44		55-64
25-34		45-54		64+

Library Card Holder

Yes

THANK YOU VERY MUCH!

PLEASE RETURN THIS QUESTIONNAIRE IN THE ENCLOSED POSTAGE-PAID ENVELOPE.

The above is based on an actual survey conducted for a library in the Nassau Library System.

Return to Community Library Survey Tutorial

Last Updated: July 29, 2009 -- asm [created January 27, 2005]; for questions or comments, contact us

Library Development

Mail Survey Example

2a. Are any members of your household handicapped to the extent that special services are required?

2b. If "yes" in question 2a: Which member of your household is handicapped and in what way?

Please answer questions 4-12 for yourself

5a. If difficult or not too easy, why is it not easy for you to get to the Library?

6b. Please record below any comments you may wish to make about available space or facilities:

9. Are there any additions or changes you would like to see in the services, resources or programs being provided by the Library?

11. Following is a list of various ways in which different people spend their leisure time.

THE FOLLOWING INFORMATION IS FOR CLASSIFICATION PURPOSES ONLY

E. Are you of Hispanic origin or decent?

F. What is the primary language spoken at home?

THANK YOU VERY MUCH!

PLEASE RETURN THIS QUESTIONNAIRE IN THE ENCLOSED POSTAGE-PAID ENVELOPE.

The New York State Library is a unit within the

University of the State of New York - New York State Education Department