OMB# 1121-0277
Date
of Expiration: XXXX
Participant Feedback
In order to help OVC TTAC better serve the field, we are reaching out to you and other participants to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy Act, and we will protect the confidentiality of your responses using procedures we have in place. Only members of the Needs Assessment and Evaluation Team have access to information that could identify respondents. Answers to these questions will only be reported after aggregating all responses, and the results will never identify you as an individual. Other participants, presenters, OVC staff, OVC TTAC staff, and your employer will not have access to what you as an individual say. Although this survey is voluntary, please note that completing this form is a requirement for receiving CEU credit./This survey is completely voluntary. If you have any questions about this survey or the evaluation, please contact [email protected].
Which modules did you complete?
MODULE |
Yes |
No |
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1 |
0 |
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1 |
0 |
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1 |
0 |
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1 |
0 |
Please indicate the extent to which you agree or disagree with the following statements.
MODULE X: Module Title |
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Not Applicable |
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1 |
2 |
3 |
4 |
5 |
NA |
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1 |
2 |
3 |
4 |
5 |
NA |
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4 |
5 |
NA |
MODULE X: Module Title |
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Not Applicable |
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1 |
2 |
3 |
4 |
5 |
NA |
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1 |
2 |
3 |
4 |
5 |
NA |
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1 |
2 |
3 |
4 |
5 |
NA |
Did the instructor provide feedback on the mastery of the learning objectives to participants? □ Yes □ No
Please indicate the extent to which you agree or disagree with the following statements.
PRESENTER 1 _______________________________ |
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Not Applicable |
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3 |
4 |
5 |
NA |
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5 |
NA |
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5 |
NA |
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4 |
5 |
NA |
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PRESENTER 2 ________________________________ |
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Not Applicable |
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1 |
2 |
3 |
4 |
5 |
NA |
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NA |
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NA |
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NA |
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Overall Session |
Strongly Disagree |
Disagree |
Neither Agree nor Disagree |
Agree |
Strongly Agree |
Not Applicable |
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4 |
5 |
NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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NA |
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5 |
NA |
Why did you take this training?
Course requirement
Job requirement
Certification
Personal learning/Professional development
Other(s): ___________________________________
Do you plan to do any of the following as a result of participating in this OVC TTAC training? (Mark all that apply.)
Share materials with colleagues
Refer colleagues to other OVC TTAC events/ resources
Train colleagues in content/skills learned at the event
Enact policy changes at my organization
Begin a new project or initiative
Strengthen evaluation or needs assessment activities
Modify outreach/marketing activities
Change my management or leadership style
Expand services to new victim populations
Expand types of services offered to victims
Expand capacity/frequency of services to victims
Pursue additional professional development
Network with other participants
Strengthen collaborative relationships with other orgs
Identify/pursue new funding resources
Other(s): _____________________________________
Please explain: ________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
Would you recommend OVC TTAC to others? □ Yes □ No
What aspects of the training were most helpful and why?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
What could have been done differently to create a better training?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do you have any other comments or suggestions?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Which of the following best describes the organization in which you work? (Mark all that apply.)
Community-Based/Grassroots
Criminal Justice Agency
Education
Faith-Based
Health Services
Human/Social Services
Legal Services
Legislation/Policymaking
Military
Research
Other (please specify): __________________________
Which types of victim services do you provide for crime victims in your current position? (Mark all that apply.)
I do not provide direct services
Child Care
Compensation/Restitution
Counseling
Crisis Intervention
Criminal Justice System Advocacy/Assistance
Medical Assistance
24-Hour Hotline
Information/Referral
Notification
Shelter
Transportation
Other (please specify): __________________________
Which of the following best describes the number of years of experience you have in your field of work? (Mark one.)
Less than 3 years
3 to 5 years
6 to 10 years
More than 10 years
Which of the following best describes your primary role in your current position? (Mark all that apply.)
Direct Delivery/Front Line Staff
Management/Administrative Staff
Consultant/Trainer
Volunteer
Other (please specify): __________________________
Which of the following best describes the population you serve? (Mark all that apply.)
National
State
Tribal
International, list country:
_______________________________
Local
Urban
Rural
Suburban
Culturally specific population(s):__________________
If you would be willing to participate in a brief followup
survey in 3 months, please provide your e-mail:
___________________________
Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or additional suggestions, please write to the OVC TTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
File Type | application/msword |
File Title | OVC TTAC - USER FEEDBACK FORM |
Author | goellen |
File Modified | 2013-09-13 |
File Created | 2013-09-13 |