Form 1 Public Survey - ind / House Hold

Appendix E:

IC4: Publication Survey

(Affected Public = Individuals or Households)

P

Public reporting burden for this collection of information is estimated to be 5 minutes per response to complete this questionnaire. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The control number for this project is 0970-0303. The control number expires on 07/31/2009.

ublication Survey

Product/Publication Title:______________________________________________________________

Please rate your agreement with the following statements using this scale:

SD – Strongly disagree

D – Disagree

N – Neither agree nor disagree

A – Agree

SA – Strongly agree

NA – Not applicable

I am satisfied with the content of this product/publication.	SD	D	N	A	SA	NA
This product/publication is useful.	SD	D	N	A	SA	NA
This product/publication was easy to read and understand.	SD	D	N	A	SA	NA
This product/publication met my needs.	SD	D	N	A	SA	NA
I can apply what I learned from this product/publication to my work, school, or personal situation.	SD	D	N	A	SA	NA
I would recommend this product/publication to others.	SD	D	N	A	SA	NA

1. How are you using or do you intend to use the information in this product/publication? (Check one)

• Personal use (personal situation, school report)

• Provide information for families

• Research

• Service delivery

• Professional development

• Program improvement

• Fundraising/grant writing

• Policy development

• Public awareness

2. What would have made this product/publication more helpful to you?

2. How did you learn about this product/publication?

• Child Welfare Information Gateway E-lert! (email/listserv notification)

• Child Welfare Information Gateway website

• Child Welfare Information Gateway staff

• Conference

• Other organization’s website or publication

• Referred by a colleague/friend

• Other: ___________________________________

2. Which of the following best describes your professional background or role in the child welfare field? (Check one.)

• CPS/Foster care professional

• Child abuse prevention/Family support professional

• Adoption professional

• Other professional:___________________

• Student (e.g., K-12 or University)

• None of the above – I contacted Information Gateway for personal and NOT professional reasons.

2. Do you have any suggestions or recommendations to make future products/publications more useful (e.g., different format, more interactive, specific topics)?