SV-2007-0001 MEPI Study of the United States Institutes Graduating Hi

Hello! It has been some time since your exchange experience. We would like to ask you some questions about the program and its impact on your life since your return home. The information you provide will help us design programs that better meet the needs of our participants. Please know that your answers will be strictly confidential and will in no way affect your participation in the program. We will use the data for analytical and evaluative purposes only.

Please feel free to give us your honest opinions. This survey is not a test, and there are no right or wrong answers. Thank you for your participation in this survey.

Privacy Act and Paperwork Reduction Act Statements:

The information solicited on this survey is requested pursuant to the Government Performance and Results Act of 1993 (P.L. 103-62) and the Mutual Educational and Cultural Exchange Act of 1961, as amended, also known as the Fulbright-Hays Act (22 U.S.C. 2451, et seq.). In order to ensure that the U.S. Department of State’s international exchange programs meet statutory program requirements (22 U.S.C. 2460(c)), the Department’s Bureau of Educational and Cultural Affairs (ECA) regularly monitors the programs, gathers data about program accomplishments, and evaluates selected ones. ECA uses the information collected to inform program design, management, and funding. All personal information that is collected through surveys is considered confidential. All responses are coded to ensure the confidentiality of individual responses. Data collected under this study will not be shared, sold, or used for fundraising purposes. Survey data and findings will be used only in an aggregate form for the express purposes of fulfilling the data needs of the outcome assessment. Responses to this survey are voluntary.

Public reporting burden for this collection of information is estimated to average forty-five (45) minutes to respond to this survey, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An Agency may not conduct or sponsor, and respondents are not required to respond to, a collection of information unless it displays a valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to: A/RPS/DIR, U.S. Department of State, Washington, D.C. 20520.

1. Exchange programs provide participants with many important opportunities for learning and engaging people from other countries. In the table below, please select the 3 accomplishments that have had the most impact on your life, since your return home.

Achievements	
Shared experience and learning about leadership
Shared experience and learning about community service
Increased my understanding of the U.S. and U.S. society, people, and culture
Made friends with American students and their families
Shared my culture with others
Other? (Write in)

2. Please elaborate on the impact of any of these or other accomplishments, not listed above.

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3. Looking back, did the MEPI Study of the United States Summer Institute program help you improve your own skills in these areas? Please check one box in each row.

	No, not at all	A little	Somewhat	A good deal
[Insert Skill 1]
[Insert Skill 2]
[Insert Skill 3]
[Insert Skill 4]
[Insert Skill 5]

4. If so, please give some example of how you have used these improved skills.

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5. Thinking about your community service experience in particular, please rate how valuable it was for:

	Not at all valuable	Neither valuable nor invaluable	Somewhat valuable	Extremely valuable
[Insert Objective 1]
[Insert Objective 2]
[Insert Objective 3]

5. Have you used the skills or experience gained during the program to do any of the following? Please check one box in each row.

	Yes	No
Participate in community service, if you hadn't done so before your left.
Share leadership skills, if you hadn’t done so before you left.
Use leadership skills in various activities, if you hadn’t done so before you left.

5. If you currently participate in any of these activities, please check the most recent role you have played. Please check all boxes that apply.

	Most recent role
Activity	Attend meetings	Plan activities and events	Lead events and activities	Train others	Serve in a leadership position	Start a new group or organization	Other
Community service
Civic activism
Political activism
Culture (arts, dance, drama, music)
Religious activities
Student clubs or organizations
Student journalism
Work with NGOs
Other (please write in)

8. If you can, please describe some of your recent activities (for example, a recent event you attended or organized, or a project you worked on).

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9. Since the completion of your program, have you faced any obstacles in reaching or accomplishing your goals? Have you been able to surmount these? Please provide examples, as appropriate.

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10. As a direct result of your participation in the exchange program, have you done or received any of the following at school or university? Please check one response for each item.

	Yes	No
Higher level of responsibilities or leadership at school/university
Organized or initiated new activities or projects at school/university
Established a new organization at school/university

11. As a direct result of your participation in the exchange program, have you done or received any of the following in your community? Please check one response for each item.

	Yes	No
Assumed a leadership role or position in your community
Organized or initiated new activities or projects in your community
Established a new organization in your community

12. Have you used the knowledge or experience gained in the program to initiate any of these formal or informal changes in your community? Please check one box in each row..

	Yes	No
Increased volunteer activities/community service
Founded an NGO or new organization
Introduced new ideas and knowledge
Introduced new initiatives, new ways of doing things
Established new exchanges
Tried to influence public opinion about the United States through the media
Established joint ventures, organizational partnerships, or linkages
Introduced new policies or procedures
Introduced new curricula, pedagogical methods, or educational standards
Became elected or appointed to a local, regional or national government position
Proposed, wrote, and/or passed a new law or treaty

13. Below is a list of different skills and abilities a leader might have. Please rate yourself as either poor, fair, good or excellent on the following characteristics. Please check one box in each row.

	Poor	Fair	Good	Excellent
Being self-reliant, being independent, relying on yourself.
Speaking in public.
Listening to other people’s suggestions or concerns.
Expressing ideas and feelings.
Working closely with people different from you.
Leading a team and motivating others.
Being flexible.
Solving problems.
Planning for the future.
Managing your time.
Managing your money.
Discussing your beliefs/values.
Willing to make changes in your community.

14. How much do you agree/disagree with the following statements about you as an individual? Please check one box in each row.

	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
I feel I have many choices in my life.
I feel I can make a difference in my family.
I feel I can make a difference in my community.
I feel I can influence people around me.

15. Upon reflection, what has participation in the program meant to you personally?

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16. Have you shared your program experience or the knowledge you gained during your exchange in any of the following ways? Please check one box in each row.

	Yes	No
Participated in media interviews (newspaper, television, radio, internet)
Gave presentations to community, neighborhood, school or university groups
Wrote newspapers articles, including editorials and opinion pieces.
Wrote academic books
Wrote non-academic books
Wrote academic articles—for journals or academic publications
Other (please write in):

17. How do you view the United States government and its relationship with your home country?

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree
The U.S. government is a trustworthy partner for my government.

18. How do you view the U.S. government and the American people? (Please check one box in each row.)

	Strongly Unfavorable	Generally Unfavorable	Neither favorable or unfavorable	Generally Favorable	Strongly Favorable
U.S. government
American people

19. To what extent do you agree or disagree with the statements below?

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
Voting is important because real decisions are made in elections.
Free and fair elections are the cornerstone of democracy.
An independent media is important to the free flow of information.
All citizens in a country should have equal rights and protections under the law, regardless of circumstances.
The Rule of Law is fundamental to a functioning democracy.
Individuals and organizations have the right to free speech and to voice opposition.
Democratic principles enhance the workplace. Supervisors should incorporate democratic principles into their management practices.

20. Have you remained in contact with people you met during your exchange program?

	
Yes
No

21. If yes, with whom have you remained in contact? Please check one box in each row.

	Yes	No
U.S. students in the program
U.S. teachers in the program
U.S. family – home stay
Program staff in U.S.
Other students you met in the U.S.

22. Have you continued to study and learn about the country you visited?

	
Yes
No

23. Do you plan to seek other opportunities for study abroad?

	
Yes
No

24. Have you encouraged your friends to travel or study abroad?

	
Yes
No

25. Home city/town: _________________

26. Geographic location: Please check one box.

I live in…	
My country’s capital city	
Another major city in my country other than the capital	
A small city, town or rural location in my country	

27. Home country: _________________

28. Date of birth (day/month/year) Ex: 20/10/1978:

29. Sex:

	
Female
Male

30. What is your ethnic background? ___________________

30. Which language do you consider to be your native language/mother tongue? __________________

32. What religious group do you consider yourself a member of our feel closest to? (Please check one.)

			
Baha’ism		Judaism
Buddhism		Shintoism
Christianity		Sikhism
Confucianism		Taoism
Hinduism		Zoroastrianism
Islam		Not close to any group
Jainism		None
		Other: (please write in) ____________________

33. What is your father’s current education level? Please check the appropriate level of schooling whether complete or incomplete.

	
No formal education
Primary education (complete or incomplete)
Secondary education (complete or incomplete)
Technical
University—first degree
University—postgraduate degree (e.g. Master’s or Ph.D.)

34. What is your mother’s current education level? Please check the appropriate level of schooling whether complete or incomplete.

	
No formal education
Primary education (complete or incomplete)
Secondary education (complete or incomplete)
Technical
University—first degree
University—postgraduate degree (e.g. Master’s or Ph.D.)

35. Which of the following do you have in your home? Please check all boxes that apply.

	
Television
Radio
Telephone
Mobile/cellular telephone
Computer
Internet access
None of the above

36. Do you know about and have you registered for the State Department Alumni website, https://alumni.state.gov?

	
Yes, I know about it and I have registered
Yes, I know about it but I have not yet registered
Yes, I know about it but I do not plan to register
No, I do not know about it

We encourage you to visit the website!

37. Thank you for completing this survey! If you have additional comments you would like to make, please do so here.

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38. How long did it take you to complete this survey? ______Minutes

SV-2007-0001 OMB No.: 1405-0158

FE 11292006 Expiration Date: 02/29/08

Estimated Burden Time: 30 minutes