Form 1 MSY Teen Leaders Advisor Final Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

0925-0643_MSY Teen Leaders_Advisor Final Survey

Media-Smart Youth® Teen Leaders Program: Advisor Satisfaction Survey (Indiv-HH)

OMB: 0925-0643

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MSY Teen Leaders Program: Advisor Satisfaction Survey

 

Thank you for your participation in the Media­Smart Youth Teen Leaders Program. We look forward to receiving your 
feedback! 
___________________________ 
 
 
 
OMB Number: 0925­0643 
Expiration Date: 10/31/2017 
 
Public reporting burden for this collection of information is estimated to average 30 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. 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. Send comments regarding this 
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: 
NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892­7974, ATTN: PRA (0925­0643). 
Do not return the completed form to this address. 

 

 

Site Information

*1. Name of Nonprofit Partner Organization:
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*2. City and State
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*3. How did you support the teen(s)/young adult(s) in conducting the program? (Please

check all that apply.)

c Made them aware of the Media­Smart Youth Teen Leaders Program opportunity
d
e
f
g
c Helped them write the application
d
e
f
g
c Helped them develop a budget
d
e
f
g
c Helped recruit participants
d
e
f
g

 

 

 

c Helped gather parent permission forms
d
e
f
g

 

c Helped teen leader(s) plan for the lessons
d
e
f
g
c Helped purchase/gather supplies
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g

 

 

c Supervised participants during the lessons
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e
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g
c Helped facilitate lessons
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e
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g
c Coordinated field trip(s)
d
e
f
g
c Other (please describe)
d
e
f
g

 

 

 

 

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Satisfaction with Media­Smart Youth Lessons

 

*4. Please rate your level of agreement with the following statements about the Media­

Smart Youth curriculum.
The lessons helped 

Strongly Agree

Agree

Disagree

Strongly Disagree

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participants think more 
critically about media 
messages.
Since being in the 
program, the participants 
have shown a stronger 
interest in making healthy 
choices, like eating 
nutritious foods or being 
physically active.
Overall, the Media­Smart 
Youth program was a 
valuable experience for the 
youth participants.
I would recommend that 
other organizations use the 
Media­Smart Youth 
curriculum.

*5. Did you observe any behavioral changes (e.g., making healthier decisions) in

participants as a result of the Media­Smart Youth program?
 

c Yes
d
e
f
g
c No
d
e
f
g

 

If yes, please describe. 

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*6. Will your organization implement Media­Smart Youth again in the future, either with

teen or adult leaders?
 

j Yes
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n
j No
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n

 

If yes, please explain why. If no, please explain why not. 

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*7. Please rate your level of agreement with the following statements about the Media­

Smart Youth Teen Leaders Program.
The program helped the 

Strongly Agree

Agree

Disagree

Strongly Disagree

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n

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teen(s)/young adult(s) in my 
community enhance their 
leadership skills.
Based on my experience 
with the program, I believe 
that teens can be effective 
leaders of the Media­Smart 
Youth curriculum.
I would recommend that 
other teens consider 
becoming Media­Smart 
Youth Teen Leaders.

*8. How can the Media­Smart Youth Teen Leaders Program be improved?
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Satisfaction with the Level of Program Support

 

*9. Please rate your level of agreement with the following statements about the level of

support you received as an advisor for the Media­Smart Youth Teen Leaders Program.
I received the support I 

Strongly Agree

Agree

Disagree

Strongly Disagree

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n

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n

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needed from the National 
Institutes of Health (NIH) 
and its contractor, IQ 
Solutions.
The webinar training I 
received at the start of the 
program was helpful.
I felt well prepared to be an 
advisor for the Media­Smart 
Youth Teen Leaders 
Program.

10. What additional support, if any, would you have liked from the NIH and/or its
contractor, IQ Solutions?
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Satisfaction as a Program Advisor

 

*11. Please rate your level of agreement with the following statements about your

experience as an advisor with the Media­Smart Youth Teen Leaders Program.
Serving as an advisor was a 

Strongly Agree

Agree

Disagree

Strongly Disagree

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positive experience.
Serving as an advisor was a 
good investment of my 
time.

*12. Overall, how satisfied were you with your experience as an advisor in the Media­

Smart Youth Teen Leaders Program?
j Very Satisfied
k
l
m
n

 

j Satisfied
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l
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n

 

j Dissatisfied
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*13. What did you like best about being an advisor?
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*14. What did you like least about being an advisor?
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j Very Dissatisfied
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Successes and Challenges

 

*15. Please describe an instance when you felt your Media­Smart Youth program was

particularly successful.

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*16. What were your site’s biggest challenges with the Media­Smart Youth program?
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*17. What advice would you have for a future advisor in the Media­Smart Youth Teen

Leaders Program?

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18. Please tell us anything else you think is important to know about your experience with
the Media­Smart Youth Teen Leaders Program.
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