PC-2146 Invitee Feedback Prior to Departure

OMB Control Number: 0420-0545

Expiration Date: 9/30/2017

VRS Survey 2: Invitee Feedback Prior to Departure

The purpose of this survey is to gather information related to your customer service experience with the Peace Corps. The information you provide is voluntary and you are free to not answer any of the following questions. In addition, your responses are anonymous and will be reported in a way that ensures that you will not be personally identifiable by the answers that you provide.

Public reporting burden for this information collection is estimated to average 5 minutes.  The Peace Corps 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: the FOIA Officer, Peace Corps, 1111 20^th Street NW, 2^nd Floor, Washington, D.C. 20526 or [email protected].

Overall, how satisfied were you with the following:
	Very Satisfied	Satisfied	Neither Satisfied nor Dissatisfied	Dissatisfied	Very Dissatisfied	Not Applicable
Customer service experience with Peace Corps recruiters						
Usefulness of Peace Corps Recruitment events						
Customer service experience with the Placement and Assessment Specialist who conducted your interview and issued you an invitation					
Customer service experience with the Office of Medical Services					
Customer service experience with the Country Desk Officer you were assigned after accepting your invitation to serve.						
Overall customer service experience with Peace Corps					

To conclude this survey, we would like to ask you a few demographic questions. As with all questions on this survey, your responses are anonymous and will be reported in a way that ensures that you will not be personally identifiable by the answers that you provide. If you do not feel comfortable sharing your demographic information, however, you are always free to skip or select "Prefer not to answer" for any of the following questions.

GENDER

What is your gender?
	Male
	Female
	Prefer not to answer

ETHNICITY

Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)
	Yes
	No
	Prefer not to answer

RACE

Please select the racial category or categories with which you most closely identify by placing an “X” in the appropriate box. Check as many as apply.
	American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
	Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
	Black or African American. A person having origins in any of the black racial groups of Africa.
	Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
	White.  A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
	Prefer not to answer

AGE

What is your age?
	18 to 25
	26 to 30
	31 to 35
	36 to 45
	46 to 55
	56 to 65
	65+
	Prefer not to answer

REGION

In which state do you live? [DROPDOWN LIST OF STATES, RECODE INTO REGION, INCLUDE PREFER NOT TO ANSWER]
	Dropdown list of States including territories
	I live outside of the United States
	Prefer to not to answer