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

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

NSTI SurveyMonkey_FY2016

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

OMB: 2125-0628

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National Summer Transportation Institute Survey FY 2016
Host Site Information (Accredited Colleges and/or Universities)

This data collection instrument is used to capture information about the NSTI program to determine
if improvements are needed. Please complete this survey no later than c.o.b. October 17th. The
link will be closed after the deadline. If you have any problems using this instrument, please
contact Joyce Gottlieb at [email protected]. If you have any questions about the NSTI
Program, please contact your State Transportation Agency. Thank you.
This collection of information is voluntary, and will be used to capture information about the Federal Highway Administration's program and
determine if improvements are needed. Public reporting burden is estimated to average 30 minutes per response, including the time for reviewing
instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Please note that 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 collection is 2125-0628. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Michael Howell, Information
Collection Clearance Officer, [email protected], 202 366-5707, Federal Highway Administration, E66-433, 1200 New Jersey Avenue, SE,
Washington, DC 20590.

1. Enter Business Contact Information of the Person Completing this Survey:
Your Full Name (Person completing form):

-- select state --

State:
Business Email Address:

2. Information about Host Site/Educational Institution where NSTI Program was held:
Name of Host Site: (no abbreviations)
City/Town:

-- select state --

State:
ZIP:

3. How long (in weeks) was your NSTI program?
1 week

4 weeks

7 weeks

2 weeks

5 weeks

8 weeks

3 weeks

6 weeks

1

4. Was your NSTI program a residential program or a non-residential program?
Residential

Non-residential

5. Select grade levels of your NSTI program?
High School

Middle School

National Summer Transportation Institute Survey FY 2016
Host Site Information (Accredited Colleges and/or Universities) continued

6. Select the transportation component(s) your program covered: (check all that apply)
Highways

Transit

Space

Bridges

Tunnels

Maritime

Rail

Aviation

STEM-focused

7. Select modal visits conducted (check all that apply)
Airports

Seaports

Transportation Centers

Bridges & tunnels

Rail

Other (please specify)

8. Select non-transportation component(s) covered in your program (check all that apply)
Job prep

Problem solving

Business etiquette

A.C.T. prep

Critical thinking

Career prep

S.A.T. prep

Communication

Interview skills

National Summer Transportation Institute Survey FY 2016
Host Site Information (Accredited Colleges and/or Universities) continued

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9. If you received monetary in-kind contributions, please enter amount in $:

10. In-kind contributions (i.e. non-monetary contributions) received (check all that apply)
equipment or supplies

transportation

staff

food

Other (please specify)

11. Type of partnership or sponsorship: (check all that apply)
schools

non-profit

businesses

faith-based organizations

National Summer Transportation Institute Survey FY 2016
FHWA Oversight

12. Did someone from your FHWA Division Office visit your site?
Yes
No

13. Did someone from your State Transportation Agency (STA) visit your site?
Yes
No

14. If you answered yes to questions 10 or 11, select discipline.
Civil Rights

Environment

Right of Way

Engineering

Planning
Other (please specify)

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National Summer Transportation Institute Survey FY 2016
Demographics

15. Enter the number of Hispanics/Latinos

16. Enter number of participants in each race category (total must equal or exceed number of participants):
American Indian or Alaskan Native

Asian

Black or African-American

Hispanic/Latino

Native Hawaiian or other Pacific Islander

White

From multiple races

17. Enter number of participants in each category (total must equal number of participants):
Female
Male
Self-Identifying Disability

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18. How many students...
Applied to your program?
Enrolled in your program?
Completed your program?
(number must not exceed
total enrollment)
Interested in
transportation-related
careers/post-secondary
education at the end of the
program?

National Summer Transportation Institute Survey FY 2016
Evaluations

19. Please answer the following:
Very Satisfied

Satisfied

Dissatisfied

Very dissatisfied

What were the overall
results of your
participants'
evaluations?
Indicate your satisfaction
level with the program

20. Did you participate in any meetings related to the NSTI hosted by the following? (select all that apply)
Federal Highway Administration

Federal Aviation Administration

State Departments of Transportation

Other

21. Areas of need: (check all that apply)
Funding

Partnerships

Technical assistance

Other

National Summer Transportation Institute Survey FY 2016
Marketing

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22. Identify your marketing strategies: (check all that apply)
newspapers/magazines

school recruitment

social media

word of mouth

surveys

website

mailings

flyers

23. What method do you use to track students who go into transportation-related studies/careers: (check all
that apply)
Social Media (i.e. Facebook, Twitter)

Email

Surveys

Phone

We do not track

Other (please specify)

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File Typeapplication/pdf
File TitleView Survey
File Modified2016-04-04
File Created2016-04-04

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