Form 1 Leadership Interview Part II-Tribes

OMB Control No.: xxxx-xxxx

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average 75 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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.

Expiration Date: xx/xx/20xx

PART II

Capacity Building Center for Tribes – Leadership Interview

(Items in red should only be asked of tailored services projects that have been completed)

Section 1: Service Provision for Your Project

1. Skip

2. Skip

Please rate how much you agree with the following statements about the services your agency received from the Center for Tribes.	4 –Strongly Agree	3 – Agree	2 – Disagree	1 –Strongly Disagree
The request and approval process for this project went smoothly.
The Center for Tribes engaged our agency in the service delivery.
The services provided gave our agency useful tools for our work.
The services received will help our agency make needed changes.
Working on this project provided an opportunity for information sharing with program stakeholders.
In general, services were conducted in a way that reflected how people from our tribe work together to accomplish something.
Our community’s values and practices were respected during the provision of services.
The Center for Tribes linked our agency to helpful resources (e.g., other providers, on-line resources, peer networks, publications, training materials).
The objectives of our project were clearly identified in advance.
The objectives of our project were met.

13. What have you learned or gained from the services provided by the Center for Tribes?

14. What did you find most useful about the services provided by the Center for Tribes?

15. What did you find least useful about the services provided by the Center for Tribes?

16. Skip (see E10)

Section 2: Center for Tribes Team

Please rate how much you agree with the following statements about the services your agency received from the Center for Tribes.	4 –Strongly Agree	3 – Agree	2 – Disagree	1 –Strongly Disagree
The Center for Tribes effectively assessed our agency’s strengths.
The Center for Tribes effectively assessed our agency’s challenges.
The Center for Tribes worked in partnership with the tribal team through all stages of the project.
The Center for Tribes was knowledgeable about the topic/content area of our project.
The Center for Tribes communicated with us in a way that fit our community’s cultural values.
The Center for Tribes was a good match for helping us address our needs/project goals.
Our ideas and desires regarding this project were solicited and respected by the Center for Tribes team.

24. Please provide any additional feedback about the Center for Tribes team:

Section 3: Overall Experience

Please rate how much you agree with the following statement about the services your agency received from the Center for Tribes.	4 –Strongly Agree	3 – Agree	2 – Disagree	1 –Strongly Disagree
Skip (Center: see G7 – G9)
Skip (Center: see G1 – G6)
I would recommend that the Center for Tribes provide services to other tribes.

28. Skip (see E10)

If the tailored services project has not yet been completed  Skip to questions 37 and 38

If the tailored services project has been completed  continue to Section 4 below

Section 4: Next Steps [this section to be used for tailored services projects that have been completed]

Please rate how much you agree with the following statements about the services your agency received from the Center for Tribes.	4 – To a great extent	3 – Quite a bit	2 – A little bit	1 – Not at all
The information provided in this project corresponded to the needs of our agency.
I understand what the “next steps” are regarding the work related to this project.
Agency staff and key stakeholders involved in the project planning and implementation understand what they have to do to move the work forward.
Our agency has the resources to support continued efforts related to this project.
Our agency intends to continue to build upon the work done through this project.

34. Please provide any additional feedback or comments about your agency’s next steps.

35. What specific “next steps” were taken since the project was completed? How will this work be sustained in the future?

36. Skip (per discussion with Center)

37. How could the Center for Tribes have improved your agency’s experience with this project?

38. Do you have any additional comments you would like to share regarding CB’s Capacity Building Centers or your experiences with the services, products, and assistance they provide?

THANK YOU

WE GREATLY APPRECIATE YOUR PARTICIPATION!