SV-2007-0017 Study of the United States Institute 2006, Students (Fol

Generic Clearance Information Collection for ECA Evaluation Program [DOS Bureau of Educational and Cultural Affairs (ECA)]

SV-2007-0017 MEPI-SA U SUS-Student Institute FINAL

Generic Clearance Information Collection for ECA Evaluation Program [DOS Bureau of Educational and Cultural Affairs (ECA)]

OMB: 1405-0158

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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 thirty (30) 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

Increased my understanding of American values, society and culture


Developed my leadership skills


Shared my experiences and learned more about community service and civic involvement


Made friends with American students


Made friends with other students in the program


Shared my culture with others


Improved my English


Other? (Write in)



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

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


  1. Looking back, did the [INSERT “MEPI” IF NEEDED] Study of the U.S. 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]






  1. If so, please give examples of how you have used these improved skills.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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



Not at all valuable

Slightly Valuable

Generally Valuable

Very valuable

Extremely valuable

[Insert Objective 1]






[Insert Objective 2]






[Insert Objective 3]








  1. 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 you 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.




  1. For each activity listed below, please indicate the most recent role you played. Please check one box in each row.


Activity

Attend meetings

Plan activities and events

Train others

Serve in a leadership position

Start a new group or organization

Other

Did not participate in this activity

Community service








Civic activism








Political activism








Culture (arts, dance, drama, music)








Religious activities








Student clubs or organizations








Student journalism








Work with NGOs









  1. 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).

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


  1. 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 box in each row.



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




  1. 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 box in each row.



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





  1. 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





  1. 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 money





Discussing your beliefs/values





Willing to make changes in your community










  1. 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.








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

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



  1. 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):




  1. 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 country.







  1. 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







  1. 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.








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



Yes


No



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



Yes

No

Other Institute program participants



Institute staff/program administrators



Institute Faculty



Student facilitators



Other students



Americans in the community whom you met



U.S. State Department staff in Washington D.C.



U.S. Embassy staff



Other (specify)

__________________________





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



Yes


No



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



Yes


No



  1. Have you encouraged friends to travel or study abroad?



Yes


No




  1. Geographic location:


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


  1. Home country: [Drop Down List]


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


  1. Sex:



Female


Male



  1. What is your ethnic background? _________________


  1. Which language do you consider to be your native language/mother tongue? _________________


  1. What religious group do you consider yourself a member of or feel closet to? (Please check one.)




Baha’ism


Shintoism


Buddhism


Sikhism


Christianity


Taoism


Confucianism


Zoroastrianism


Hinduism


Not close to any group


Islam


None


Jainism


Other: (please write in)

____________________


Judaism




  1. 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



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

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


  1. How long did it take you to complete this survey? ______ Minutes

12 OMB No.: 1405-0158

Control No: SV2007-0017

Expiration Date: 02/29/08

Estimated Burden Time: 30 minutes

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