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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.
On what date did you attend the [Name of Artist/Program] event? (select one from the drop‐
down list)
Date and Time
Date and Time
Date and Time
The following questions pertain to the performance you just attended. Before answering these questions,
you may wish to close your eyes for a moment and imagine yourself back at the performance, 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 publisher
or literary organization that sponsored the reading?
☐ ☐ ☐
B. Were you exposed to at least one type or style of literature that
you had not heard before?
☐ ☐
☐
C. Were you exposed to the work of a writer whose work you’d not
known before?
☐ ☐
☐
D. Were you exposed to at least one unfamiliar literary work, even if
you were previously familiar with the artist(s) who created it?
☐ ☐ ☐
E. Were you exposed to a different interpretation of a literary work
you had previously heard?
☐ ☐ ☐
During the performance did you lose track of time and get fully absorbed? (select one)
YES
NO,
Not at All
☐
A Little
☐
☐
Somewhat
☐
☐
Completely
☐
Not
Applicable
☐
Page 2 of 5
3.
Following is a list of words that might describe how the exhibition 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 performance make you feel?
_______________________________________________________________________________
_______________________________________________________________________________
5.
As a result of attending this event, how interested are you in attending performances
featuring similar artistic work? (select one)
☐ Much less interested
☐ Less interested
☐ No change
☐ More interested
☐ Much more interested
Page 3 of 5
6.
Did you leave the performance 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 performance made you think about.
7.
Did the performance raise questions in your mind that you would like to ask the performers or
creators of the work? (select one)
☐ No
8.
Did the performance 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 performance motivate you to take some action, or make a change?
(select one)
YES
Not at All
11.
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
Did the performance 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
☐
A Little
☐
☐
Somewhat
☐
☐
Very Much
☐
Not
Applicable
☐
Page 4 of 5
13.
Overall, what was most meaningful to you about the artistic program?
_______________________________________________________________________________
_______________________________________________________________________________
Next, please answer a few questions about your ticket to the performance.
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.
17.
How knowledgeable are you about literature? (select one)
☐ Not very knowledgeable ☐ Somewhat knowledgeable
☐ Very knowledgeable
Have you had any experience with performing at spoken word events, writing literature, or
storytelling? (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 |