Cjan Meeting Participant Feedback Form

COMMUNITY JUSTICE ADVISORY NETWORK
(CJAN) MEETING
PARTICIPANT FEEDBACK FORM

Form Approved
OMB No. 3225-0002
Exp. Date: 02/28/2017
Form: PRA-ID-3

TODAY’S DATE: ______________________
CSOSA thanks you for your attendance and participation in today’s CJAN meeting. In order to help us make
needed enhancements in future CJAN meetings, we respectfully request that you complete the following survey.
Your completion of this survey is entirely voluntary. Refusing to complete this survey will not result in any
penalties. Your responses are important, encouraged and will be treated as confidential. Your responses will
only be disclosed as permitted under the Privacy Act (5 U.S.C. 552a).
Once you have completed filling out the survey, please place face down in the designated drop near the exit
door. Thank you.
Please, indicate how much you agree with the following statements. Circle your answer.

1. The purpose of the CJAN meeting was clearly introduced by facilitators at the start of the meeting.
Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

2. The information covered in this CJAN meeting will be useful to you.
Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

3. Please circle the number that best describes the overall quality of the CJAN meeting.
Note that (5) indicates the highest quality and (1) indicates the lowest quality.
5

4

3

2

1

4. What suggestions do you have for improving future CJAN meetings?

_____________________________________________________________________________________
_____________________________________________________________________________________
5. What topics would you like added to future CJAN meetings surrounding criminal justice issues?

_____________________________________________________________________________________
_____________________________________________________________________________________

Public reporting burden for this collection of information is estimated to be 4 minutes, 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 another aspect of this collection of information, including suggestions
for reducing this burden to:
Court Services and Offender Supervision Agency | Office of Research and Evaluation | 601 Indiana Ave. NW, Suite 512 |
Washington, DC 20004
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 Office of Management and Budget (OMB) control number.