Form Webinar Podcast Fo Webinar Podcast Fo Webinar Podcast Form

OMB No. 0930-xxxx

Expiration Date: xx/xx/xx

Public Burden Statement: 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 OMB control number for this project is 0930-xxxx.  Public reporting burden for this collection of information is estimated to average 15 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.

SAMHSA DTAC Webinar and Podcast Feedback Form

Thank you for participating in [name of webinar or podcast]. Please take a few minutes to answer the questions below to tell us what you think about this [webinar or podcast]. Your responses will help us continue to enhance the materials we provide.

Participation is completely voluntary. You can choose whether or not to take the feedback form; you can skip any questions or stop without finishing the feedback form. Whether or not you complete the feedback form will not affect any services you receive from SAMHSA DTAC. Click one of the options below. If you click on “Start Survey Now” you are giving SAMHSA DTAC permission to analyze and report on your responses to support making changes and improvement to the webinars and podcasts SAMHSA DTAC provides in order to better meet user needs.

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1. How did you hear about this [webinar or podcast]?

• An email from SAMHSA

• The SAMHSA website

• A colleague

• Some other way [specify]:

2. What are your primary job roles? (select all that apply)

• Mental health professional

• Substance abuse professional

• Emergency responder

• State/territory/tribe government disaster behavioral health, mental health, or substance abuse coordinator

• Other state government employee [specify]:

• Local government disaster behavioral health, mental health, or substance abuse employee

• Other local government employee [specify]:

• Federal government employee [specify agency and title]:

• Other [specify]:

3. To what extent were the topics covered relevant to your job?

• Not at all relevant

• A little bit relevant

• Somewhat relevant

• Very relevant

• Extremely relevant

4. How much new information did you learn during this [webinar or podcast]?

• None

• A little bit

• Some

• A great deal

5. How confident are you that you could apply the information learned during the [webinar or podcast] to your work?

• Not at all confident

• Somewhat confident

• Confident

• Very confident

• Extremely confident

6. Please rate your satisfaction with the following aspects of the [webinar or podcast]: (Grid with the following response options: Not at all satisfied; Somewhat satisfied; Satisfied; Very satisfied; Completely satisfied)

1. [IF WEBINAR]: Webinar software

2. [IF WEBINAR]: Level of interaction between presenter and attendees

3. Quality of visual aids used by the presenter

4. Number of visual aids used by the presenter

5. The way the presenter(s) spoke (e.g., tone, volume, clarity, speed)

7. What are one or two ways that the [webinar or podcast] could be enhanced?

8. The [webinar or podcast] was…

• Too short

• Too long

• About the right length

9. Overall, how satisfied are you with this [webinar or podcast]?

• Not at all satisfied

• Somewhat satisfied

• Satisfied

• Very satisfied

• Completely satisfied

10. Would you recommend this [webinar or podcast] to a colleague?

• Yes

• No

1. Why or why not?

1. Please use the space below to provide any additional feedback you have regarding this [webinar or podcast].

Thank you for taking the time to complete this feedback form!