Form A: Feedback Form for
Bullying Prevention Training Module Participants
(Completed
Immediately After the Training)
Thank
you for your participation in the Bullying Prevention Training. This
form will be used to assess the Training Module and Community Action
Toolkit resources. Your feedback on the content and quality of the
Training Module and Community Action Toolkit is appreciated.
Participant
Information
Please provide your name and email address to receive a short follow-up survey in approximately 4 months.
Trainee Name: (optional) Email: (optional)
Name/Address of Organization (optional): ____________________________________
Feedback: Bullying Prevention & Response Training and Continuing Education Online Program
What profession/sector do you represent?
Education
Health & Safety
Law Enforcement
Child Care/After-School & Out-of-School Care
Faith-Based
Corporation or business
Mental Health & Social Service
Parents & Caregivers
Youth Leaders Organizations
City/County Recreation
Government & Elected Officials
Other, please specify:__________________
Please rate how satisfied you are overall with the bullying prevention continuing education online course.
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
Before this training, how knowledgeable were you about the issue of bullying and best practices in bullying prevention?
Very knowledgeable
Knowledgeable
Somewhat knowledgeable
Not at all knowledgeable
After this training, how knowledgeable are you about the issue of bullying and best practices in bullying prevention and response?
Very knowledgeable
Knowledgeable
Somewhat knowledgeable
Not at all knowledgeable
After completing the training, how likely are you to do the following (please select one response per row):
Activity |
Very Likely |
Likely |
Unlikely |
Very Unlikely |
Acquaint colleagues/staff about bullying |
|
|
|
|
Conduct bullying awareness workshop at regional or national conferences |
|
|
|
|
Hold a bullying awareness workshop for a local chapter/association/meeting of colleagues (single sector) |
|
|
|
|
Organize a multi-agency/discipline group to convene a town hall or community event to raise awareness |
|
|
|
|
Organize a multi-agency/discipline group to convene a community event and facilitate action plans for prevention responses |
|
|
|
|
What did you like most about the training?
What aspects of the training could be improved?
Thank you for taking the time to provide feedback!
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 0915-0212. Public reporting burden for this collection of information is estimated to average .16 hours per response, including the time for reviewing instructions, searching existing data sources, 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 HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | John Chibnall |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |