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pdfOMB Control #: 3135‐0130
Expiration Date: 4/25/2014
Today, along with thousands of other Americans, you played an important role in the cultural life of
our country by attending an arts program.
The National Endowment for the Arts supports hundreds of arts performances, exhibitions and film
screenings every year, including the event you just attended.
Now, I invite your feedback.
Please complete this questionnaire when you get home, preferably within 24 hours.
Your responses will help the Endowment understand how audiences are impacted by the
performances, exhibitions and film screenings it funds.
You must be at least 18 years old to respond. Your answers are anonymous and confidential, so
please be as candid as possible.
Thank you.
Rocco Landesman
Chairman
Paperwork Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless such collection displays a valid OMB control number. The valid OMB control number for this information
collection is 3135‐0130. The estimated time to complete this questionnaire is 10 minutes. If you have any comments
concerning the accuracy of the time estimate(s) or suggestions for improving this survey, please contact Elizabeth
Holland at [email protected].
; Begin Here
1.
What is the name of the theater or venue that you attended?
_______________________________________________________________________________
2.
What is the name of the film that you saw?
_______________________________________________________________________________
3.
On what date did you attend the film? _______________________________________
The following questions pertain to the film you just attended. Before answering these questions, you may
wish to close your eyes for a moment and imagine yourself back at the film, thinking about what you
saw, heard, and felt.
1.
2.
No
Select an answer for each question.
Yes
Not Sure
or Not
Applicable
A. Were you already familiar with the artistic work of the film whose
work was shown?
☐ ☐ ☐
B. Were you exposed to at least one type or style of film that you
had not [heard/seen] before?
☐ ☐
☐
C. Were you exposed to the work of a filmmaker whose work you’d
not known before?
☐ ☐
☐
D. Were you exposed to at least one unfamiliar film, even if you
were previously familiar with the artist(s) who created it?
☐ ☐ ☐
E. Were you exposed to a different interpretation of a film you had
previously seen?
☐ ☐ ☐
During the film did you lose track of time and get fully absorbed? (select one)
YES
NO,
Not at All
☐
A Little
☐
☐
Somewhat
☐
☐
Completely
☐
Not
Applicable
☐
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3.
Following is a list of words that might describe how the film made you feel. Indicate how
much you felt each of these things at any point during the artistic program.
Please respond in reference to how the art itself made you feel. If the [program/exhibit/film] you
attended included multiple artistic works, and at least one of them made you feel a certain way,
please report it.
Not
A
at all little
4.
A
lot
Not
Applicable
Not
at all
A
little
A
lot
Not
Applicable
Peaceful
☐ ☐ ☐
☐
Intrigued
☐ ☐ ☐
☐
Distressed
☐ ☐ ☐
☐
Offended
☐ ☐ ☐
☐
Inspired
☐ ☐ ☐
☐
Amused
☐ ☐ ☐
☐
Compassionate
☐ ☐ ☐
☐
Confused
☐ ☐ ☐
☐
Excited
☐ ☐ ☐
☐
Provoked
☐ ☐ ☐
☐
Sad
☐ ☐ ☐
☐
Bored
☐ ☐ ☐
☐
Fulfilled
☐ ☐ ☐
☐
Amazed
☐ ☐ ☐
☐
Refreshed
☐ ☐ ☐
☐
Contemplative
☐ ☐ ☐
☐
In your own words, how did the film make you feel?
_______________________________________________________________________________
_______________________________________________________________________________
5.
As a result of attending this event, how interested are you in attending filmsfeaturing
similar artistic work? (select one)
☐ Much less interested
☐ Less interested
☐ No change
☐ More interested
☐ Much more interested
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6.
Did you leave the film with an impulse or idea for being more creative in your own life or
work? (select one)
☐ No
☐ Yes
☐ Not Applicable
Next, please answer a few questions about what the film made you think about.
7.
Did the film raise questions in your mind that you would like to ask the performers or creators
of the work? (select one)
☐ No
8.
Did the film cause you to think about an issue or topic? (select one)
☐ Yes
‐ a few questions
☐ Yes – a lot of questions
YES
NO,
Not at All
☐
9.
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
To what extent did you gain new insight or learning? (select one)
YES
Not at All
10.
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
To what extent did the film motivate you to take some action, or make a change? (select one)
YES
Not at All
1
1.
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
Did the film explore or celebrate your own cultural background or identity? (select one)
YES
NO,
Not at All
12.
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
Did the artistic program give you a new appreciation for people who are different than you, or
for a culture other than your own? (select one)
YES
NO,
Not at All
13.
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
Overall, what was most meaningful to you about the artistic program?
_______________________________________________________________________________
Page 4 of 5
_______________________________________________________________________________
Next, please answer a few questions about your ticket to the film.
14.
Who purchased your ticket or paid your entrance fee? (select one)
☐ I did
☐ Someone else did
☐ No ticket or fee was required (skip to
question 15)
15.
If you had a ticket, what type of ticket did you hold? (select one)
☐ Subscription or series ticket
☐ Individual ticket
☐ Complimentary ticket
☐ Special group ticket
Next, please answer a few questions about your prior experience with arts.
16.
How knowledgeable are you about film? (select one)
☐
☐ Somewhat knowledgeable
Not very knowledgeable
knowledgeable
☐ Very
17.
Have you had any experience with making films or videos as an artistic activity? (select one)
☐ No
☐ Yes – earlier in my life ☐ Yes – this is a current activity for me
Finally, please answer a few questions about yourself. Your answers are anonymous and confidential.
18.
In what year were you born? (write in year): ________________________
19.
20.
What is your sex? (select one)
☐ Male ☐ Female
What is the highest level of school you have completed or the highest degree you have
received? (select one)
☐ Less than 9 grade
☐ Some high school
☐ High school grad (GED)
21.
Do you consider yourself to be Hispanic or Latino? (select one)
th
☐ Some college
☐ College graduate
☐ Advanced graduate degree
☐ No
22.
Which category or categories best describe your race? (select one or more)
☐ Yes
☐ White
☐ Black or African American
☐ American Indian or Alaska Native
☐ Asian
☐ Native Hawaiian or Other Pacific Islander
Page 5 of 5
| File Type | application/pdf |
| File Title | September 12, 2003 |
| Author | Alan Brown |
| File Modified | 2011-12-21 |
| File Created | 2011-12-21 |