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.

  1. Which of these ways do you like very much to spend your own leisure time? (Check as few or as many as you like.)
  2. Whether or not you like them very much, which ones do you spend most of your leisure time doing?
  3. 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

No


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