Form 1 MSY Teen Leaders Nonprofit Partner Final Survey

MSY Teen Leaders Program: Nonprofit Partner Satisfaction Survey

Thank you for your feedback on the Media­Smart Youth Teen Leaders Program. Your feedback makes our program 
better! 
___________________________ 

OMB Number: 0925­0643 
Expiration Date: 10/31/2017 

Public reporting burden for this collection of information is estimated to average 20 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. 

*1. Name of Organization:
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*2. City and State
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*3. How did you support the teen(s)/young adult(s) with the Media­Smart Youth Teen

Leaders Program? (Please check all that apply.)
c Transferred award funds
d
e
f
g

c Provided consultation/advice
d
e
f
g
c Provided use of facilities
d
e
f
g

c Provided other resources, such as free materials, copies, and/or transportation
d
e
f
g
c Assisted with promotion and/or recruitment
d
e
f
g
c Other (Please describe)
d
e
f
g

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*4. As the nonprofit partner, did you find the administrative requirements to be

reasonable?

j Yes
k
l
m
n
j No
k
l
m
n

Why or why not? Please explain. 

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*5. Did you have any difficulty completing the Memorandum of Understanding or

receiving/transferring funds?

j Yes
k
l
m
n
j No
k
l
m
n

Please explain. 

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*6. What did you like best about being a nonprofit partner in this program?
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*7. What did you like least about being a nonprofit partner in this program?
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*8. Do you think the Media­Smart Youth lessons were valuable for the youth

participants?

j Yes
k
l
m
n
j No
k
l
m
n

Why or why not? 

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*9. Do you think the Media­Smart Youth Teen Leaders Program was a valuable

experience for the teen leader(s)?

j Yes
k
l
m
n
j No
k
l
m
n

Why or why not? 

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*10. Overall, how satisfied were you with your experience as a nonprofit partner in the

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

j Satisfied
k
l
m
n

j Dissatisfied
k
l
m
n

j Very Dissatisfied
k
l
m
n

*11. Will you support a Media­Smart Youth program again in the future, either with teen or

adult leaders? Why or why not?

j Yes
k
l
m
n
j No
k
l
m
n

Why or why not? 

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12. Please provide any additional feedback you’d like to share about Media­Smart Youth
and/or the Teen Leaders Program specifically.
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