Form A Attachment A -Webinar Customer Satisfaction Survey

OMB Control Number: 0915-0212

Expiration Date: 05/31/2018

Webinar Customer Satisfaction Survey

Please fill out this brief survey and tell us about the webinar: [TITLE]

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 0.12 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 aspects of this collection of information, including suggestions for reducing burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, MD, 20857.

1. What is your project role?

1. State/territory recipient

2. Project Officer

3. DHVECS staff

4. ACF staff

5. (HV) Technical Assistance Provider

6. Local Implementing Agency (LIA) staff

7. Model Developer

8. Other, please explain: (space for them to write in answer)

2. Which state/territory are you from?

   1. Drop down list of 50 states, Washington D.C., and 5 territories (Guam, U.S. Virgin Islands, Commonwealth of the Northern Mariana Islands, Puerto Rico, American Samoa)

(Matrix) Please tell us the extent to which you agree or disagree with the following statements.
The webinar helped support our program mission to deliver evidence-based home visiting services.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable
This webinar provided my organization with opportunities to engage in learning about a topic in which we need support.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable
This webinar enhanced my organization’s ability to support LIAs in addressing an identified need.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable
This webinar connected me with resources that are useful for my organization’s home visiting needs.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable

(Matrix) Overall, how satisfied were you with the following items?
The quality of the webinar content.
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
The timeliness of the webinar content.
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied
The quality of the presenters leading the webinar.
Extremely satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Extremely dissatisfied

(Matrix) Please indicate the extent to which you agree or disagree with the following statements.
The webinar improved our ability to reach our performance measures.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable
The webinar increased our capacity to engage families.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable
The webinar increased the knowledge and skills of our workforce.
Strongly agree	Somewhat agree	Neither agree nor disagree	Somewhat disagree	Strongly disagree	Not applicable

6. (Open-ended) What aspects of the webinar were most useful?

7. (Open-ended) What can we do to improve future webinars?

8. (Open-ended) What topics or subjects would you like us to include in future webinars?