Form 1 Voluntary Organizations

NHTTAC Consultant and Evaluation Package

2_Voluntary_Organizations

Voluntary Feedback for Organizations

OMB: 0970-0519

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0519 can be found here:

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ORGANIZATIONAL
SCHOLARSHIP FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

In order to help the National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we
are reaching out to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy
Act, and we will protect the confidentiality of your responses using procedures we have in place, including reporting all
information in aggregate to avoid identifying information. Only members of the NHTTAC Evaluation Team have access to
information that could identify respondents. If you have any questions about this survey or the evaluation, please contact
[email protected].
Please provide the information below to create an anonymous ID:
______

______

Birth Month
First letter of first name
(insert just the month
(example: S for Sara)
for your date of birth,
example: 08 for August)

First letter of your middle name
(example: M for Maria)

Part I: NHTTAC Scholarship Program
1.

How did you hear about this NHTTAC Scholarship Program? (Mark all that apply.)
□
□
□
□

NHTTAC Website
Exhibit or presentation at a conference
NHTTAC listserv
OTIP program monitor or other OTIP staff person

□
□
□
□

Another organization
A colleague or friend
A publication or newsletter
Other (please specify): __________________________

What month and year did you apply? ________________________

Would you recommend the NHTTAC Organizational Scholarship to others?

□ Yes

□ No

Please indicate the extent to which you agree or disagree with the following statements.

APPLICATION PROCESS

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

NHTTAC was responsive to my questions and needs.

The application was easy to complete.

The application instructions clearly explained the
eligibility requirements.

The application instructions clearly explained the expenses
covered under the program.

I am satisfied with the notification process.

I am satisfied with the overall application process by
NHTTAC.

10. What could be done differently to improve the application process?

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 10 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

ORGANIZATIONAL
SCHOLARSHIP FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

11. Do you have any other comments or suggestions?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Part II: Event Feedback

12. Please provide the following information about the event you were awarded funds to attend:
Event title: ___________________________________________________________________________________________
Date(s): ______________________________

Location: ____________________________________________________

Event Description: ____________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Please indicate the extent to which you agree or disagree with the following statements.
Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

13. The event increased my knowledge related to the topic(s).

14. The information presented in the event was grounded in
current evidence-based research or promising practices.

15. The information presented in the event was traumainformed.

16. The information presented in the event was survivorinformed.

17. The information presented in the event was grounded in a
multidisciplinary approach to addressing human
trafficking.

18. The information provided in the event reflected a public
health approach to addressing human trafficking.

19. The event improved my ability to serve people who are
currently being trafficked, at risk of trafficking, or have
been trafficked.

20. The education materials provided for this event were
useful.

21. The event increased my practical skills related to the
topic(s).

22. The event met my professional needs.

23. The event met my educational needs.

24. I will be able to apply what I learned in my work.

EVENT FEEDBACK

ORGANIZATIONAL
SCHOLARSHIP FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol
25. Please rate the overall quality of this scholarship program.
1

Poor

Fair

Good

Excellent

26. As a result of participating in this scholarship program, do you plan to do any of the following? (Mark all that apply.)

□
□
□
□
□
□
□
□
□
□

Change my management/leadership or
interpersonal communication style
Further develop skills and knowledge about serving
people who are currently being trafficked, at risk of
trafficking, or have been trafficked
Write grants/fundraise/identify new funding
resources
Advocate or meet with leadership of my
organization to develop/enhance vision, mission, or
strategic plan
Advocate or meet with leadership of my
organization to develop/enact policy changes at my
organization
Improve programs/practices
Improve technology/websites/infrastructure
Integrate victim-centered, survivor-informed
strategies
Expand services or types of services
Begin a new project or initiative

□
□
□
□
□
□

Develop/strengthen collaborative or strategic
relationships
Network with other participants
Share materials with colleagues
Provide information to clients/families/youth
Train/educate others in content/skills learned
Raise public awareness/advocacy/outreach
activities offered to people who are currently being
trafficked, at risk of trafficking, or have been
trafficked
Refer colleagues to NHTTAC events/resources
Conduct research
Strengthen evaluation or needs assessment
activities
Improve identification and reporting methods for
trafficking
Take additional training on human trafficking
Other (please specify): __________________

27. Of the barriers listed below, which do you believe will be a significant challenge to performing the activities you selected in
the previous question? (Mark all that apply.)

□
□
□
□
□
□
□
□
□

Lack of senior leadership support
Lack of frontline support and accountability
Continuous turnover
Shortages of key personnel
Competing priorities
Inaccessible research and/or information
Lack of urgency
Lack of shared responsibility across organizational
collaboration
Difficulty in establishing and/or maintaining a
multi-disciplinary team

□
□
□
□
□
□

Need for partnership building with other
organizations
Variation in mission and regulatory frameworks
when partnering with other organizations
Lack of information and/or data sharing among
organizations
Lack of time to implement changes
Lack of training for staff in how to implement
change
Other (please explain): _________________

28. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes

□ No

29. Which of the following best describes the organization in which you work? (Mark all that apply.)

□
□
□
□

Academic institution
Anti-trafficking organization
Business/For-profit organization
Coalition/Multidisciplinary team/Task force

□
□
□
□

Federal government
Faith-based organization
State and local government
Nonprofit/Community-based organization

ORGANIZATIONAL
SCHOLARSHIP FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol
□
□
□
□

□
□
□

OTIP grantee
Self-employed
Survivor-led organization
Tribal government

Union/Worker advocacy organization
Victim service provider
Other, please specify: _____________________

30. Which of the following best describes your professional capacity or types of services you provide? (Mark all that
apply.)
□ Behavioral health professional (e.g., psychologist,
□ Legal (e.g., immigration, civil and/or rights-based
psychiatrist, mental health/substance use counselor)
attorney and/or paralegal, clinic)
□ Child welfare (e.g., state agency staff, child welfare
□ Public health (e.g., licensure board, health
contractor, nonprofit personnel)
department staff, health care executive, community
□ Corrections-based services (e.g., parole, probation)
health workers)
□ Criminal justice (e.g., law enforcement, prosecutor,
□ Social worker (e.g., case manager, school
probation, court, forensic interviewer)
counselor, supervisor, administrator)
□ Educator (e.g., teacher, professor, school
□ Survivor empowerment, mentoring, or peer to peer
administrator)
□ Violence prevention (e.g., Child abuse and neglect;
□ Health care (e.g., physician, physician assistant,
elder abuse; domestic violence, sexual violence,
nurse practitioner, dentist, nurse, pharmacist)
youth violence)
□ Housing (e.g., case worker, shelter director, public
□ Other (please specify):
_______________________________
housing authority agencies)
31. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years

□ 3 to 5 years

□ 6 to 10 years

□ More than 10 years

32. Which of the following best describes your primary role in your current position?
□ Direct Delivery/frontline staff
□ Consultant/Trainer
□ Management
□ Volunteer
□ Other (please specify): _______________

□ Administration
□ Peer Educator

33. In your professional capacity, how frequently do you come into contact with people who are currently being trafficked, at risk
of trafficking, or have been trafficked?
1

Never

Rarely

Frequently

All the Time

34. Which of the following best describes your geographic population? (Mark all that apply.)
□
□
□
□

National
State (please specify): ______________
Tribal
International (please specify country):
_________________________________

□

Local
□ Urban
□ Rural
□ Suburban

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The estimated average time to complete this form is 10 minutes. If you have comments regarding the accuracy of this estimate or additional suggestions,
please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

ORGANIZATIONAL
SCHOLARSHIP FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol
35. Please select any of the following populations you currently work with in a professional capacity (Mark all that apply.)

□

□
□
□
□

Human trafficking
□ Commercial sexual exploitation of
children
□ Sex trafficking
□ Adults
□ Minors
□ Labor trafficking
 Adults
 Minors
Children/youth
□ Out of home/Foster care/Kinship care
□ Juvenile justice
□ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning

□
□
□

□
□
□
□
□

Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaii or other Pacific Islander
□ White
□ Hispanic or Latino ethnicity
History of substance use
Domestic and dating violence
Gang-related crime
Sexual abuse/Violence
Other (Please specify): __________________

36. What is your race? (Mark all that apply.)

□
□
□
□
□
□

American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify): _______________________________________

37. What is your ethnicity? (Mark all that apply.)

□
□
□

Hispanic or Latino
Middle Eastern or North African
Other (please specify): ________________________________________

38. What is your gender? (Mark all that apply.)

□
□
□
□

Male
Female
Transgender
Other (please specify): ________________________________________

Thank you for taking the time to complete this form and helping to improve NHTTAC activities.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number.
The estimated average time to complete this form is 10 minutes. If you have comments regarding the accuracy of this estimate or additional suggestions,
please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

OTIP GRANTEE
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

______

Birth Month
(insert just the month
for your date of birth,
example: 08 for August)

First letter of first name
(example: S for Sara)

First letter of your middle name
(example: M for Maria)

EVENT: __________________________________________________________________________________________
DATES(S): _____________________________________________________
FACILITATOR(S): ________________________________________________________________________________

Please select the number that best represents your rating for each session and objective:
SESSION FEEDBACK

Poor

Fair

Good

Excellent

Not Applicable

[Insert Session].

Poor

Fair

Good

Excellent

Not Applicable

OBJECTIVE FEEDBACK
8.

[Insert Objective 1].

[Insert Objective 2].

10. [Insert Objective 3].

OTIP GRANTEE
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

Please indicate the extent to which you agree or disagree with the following statements:
Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

11. The facilitator’s knowledge and expertise were
appropriate for the meeting.

12. The facilitator presented the content clearly and
logically.

13. The facilitator responded positively to questions
and comments.

14. The facilitator created a respectful environment for
participants.

15. The facilitator encouraged and initiated helpful
discussions.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

16. The facilitator’s knowledge and expertise were
appropriate for the meeting.

17. The facilitator presented the content clearly and
logically.

18. The facilitator responded positively to questions
and comments.

19. The facilitator created a respectful environment for
participants.

20. The facilitator encouraged and initiated helpful
discussions.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

21. The meeting was organized and clear.

22. The meeting content was trauma-informed.

23. The meeting content was survivor-informed.

24. The meeting content was grounded in evidencebased research or promising practices.

25. The meeting content was grounded in a
multidisciplinary approach to addressing human
trafficking.

26. The meeting content reflected a public health
approach to addressing human trafficking.

27. The meeting provided ample opportunity and
encouragement for participants to meaningfully
interact with each other.

FACILITATOR 1: ____________________

FACILITATOR 2: ____________________

EVENT FEEDBACK

OTIP GRANTEE
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

28. The time allotted was appropriate for completing
all agenda items.

29. The meeting met my professional needs.

30. The meeting met my educational needs.

31. Overall, this was an effective way to support the
content and purpose of the meeting.

32. NHTTAC staff effectively responded to any
obstacles or challenges.

Please select the number that best represents your rating for this event for each of the following questions:
33. Please rate the overall quality of this meeting.
1

Poor

Fair

Good

Excellent

34. How useful was this meeting to your work?
1

Not Useful

Somewhat Useful

Useful

Very Useful

35. In your professional capacity, how frequently do you come into contact with people who are currently being trafficked, at risk
of trafficking, or have been trafficked?
1

Never

Occasionally

Frequently

All the Time

36. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□

Yes

□ No

Please rate the following registration, premeeting service, and logistical arrangements using the
following scale:
Poor

Fair

Good

Excellent

Not
Applicable

37. Meeting registration

38. Onsite registration check-in process

39. Attendee meeting packet

40. Meeting direction signs

41. Conference meeting room

42. Travel information (if applicable)

LOGISTICS

OTIP GRANTEE
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol

43. Hotel accommodations (if applicable)

44. As a result of participating in this meeting, do you plan to do any of the following? (Mark all that apply.)

□
□
□
□
□
□
□
□
□
□

□
□
□
□
□
□

45. Of the barriers listed below, which do you believe will be a significant challenge to performing the activities you selected in
the previous question? (Mark all that apply.)

□
□
□
□
□
□
□
□
□

46. Would you recommend NHTTAC to others for T/TA?

□
□
□
□
□
□

□ Yes

□ No

47. What could NHTTAC have done differently to better support the objectives of this meeting?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
48. What was most helpful about this meeting and why?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 10 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

OTIP GRANTEE
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Protocol
49. Are there any topics you would like to learn more about next time?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
50. Do you have any other comments or suggestions?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 10 minutes. If you have comments please write to the NHTTAC Evaluation Team at
[email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SOAR ORGANIZATIONAL
LMS FEEDBACK FORM

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Agency: ______________________________________________________________________________

Which of the following best describes the reason your organization incorporated SOAR training into its learning management
system (LMS)? (Mark one.)
□
□
□
□

□

To better provide services to victims/at-risk populations
For use in program development/operations
For education/community outreach
To train staff/faculty/victim service providers
To address a training mandate
Other (please specify): __________________________

In the past year, approximately how many employees at your organization took the SOAR training? ______________

In the past year, approximately how many employees worked at your organization? _________________________

How was the LMS training disseminated in the organization?

Was it required for nonmanagement personnel? □

Was it required for management?

Does your organization have a current policy for when a person who is currently being trafficked, at risk of trafficking, or has
been trafficked receives services about:

□

Yes

Yes
□

□
□

Optional

□

Mandatory



Screening



Referrals



Reporting



In the past year, have you changed your policies for when a person who is currently being trafficked, at risk of trafficking, or
has been trafficked receives services about:


Screening



Referrals



Reporting



Please indicate the extent to which you agree or disagree with the following statements:

CONTENT
9.

The training content was applicable to our
organization.

Strongly Disagree

Disagree

Agree

Strongly Agree

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 8 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SOAR ORGANIZATIONAL
LMS FEEDBACK FORM

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

10. The training content helped our organization improve
its efforts to prevent human trafficking.
11. The training content helped our organization improve
its efforts to identify human trafficking.
12. The training content helped our organization improve
its efforts to respond to human trafficking.
13. The training content was helpful to our organization for
developing or revising internal protocols
14. The training content was helpful to our organization to
expand our referral and resource networks.
15. The training was survivor-informed.
16. The training was trauma-informed.
17. The training was grounded in a multidisciplinary
approach to addressing human trafficking
18. The training reflects a public health approach to
addressing human trafficking.

LOGISTICS

1
1

2
2

3
3

4
4

Strongly Disagree

Disagree

Agree

Strongly Agree

19. NHTTAC was helpful in assisting our organization to
incorporate SOAR into our Learning Management
System.
20. The process for integrating the training into our
organization’s LMS was clearly explained.
21. The training format was a good fit for our organization.
22. The continuing education requirements were clearly
explained.
23. The training content was appropriate for our
organization.

24. Please rank order the modules from 1 (least relevant) to 7 (most relevant) that align with the training needs of your
organization.
___Module 1:
___Module 2:
___Module 3:

___Module 4:
___Module 5:
___Module 6:
___Module 7:

25. Please rate the overall quality of this training.
1

Poor

Fair

Good

Excellent

26. Were there any technical problems?

□

Yes

□

If yes, were the technical issues with the: □ SOAR training content
□ Other (please specify): ___________________________

□ Organization’s system

27. What additional resources could NHTTAC have provided to your organization to help facilitate the incorporation of this
SOAR training?

____________________________________________________________________________________
____________________________________________________________________________________
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 8 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SOAR ORGANIZATIONAL
LMS FEEDBACK FORM

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

28. Has your organization proposed or changed policies pertaining to victims of human trafficking since receiving the training?
□ Yes
□ No
If yes, what are the proposed or implemented policies?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
29. In the past year, have you assisted other organizations with their policy changes for victims of human trafficking?
□

Yes □

If yes, please explain.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
30. What are other opportunities for policy and process change at your organization?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
□

31. Would you recommend this SOAR online training to other organizations?

Yes

□

32. How frequently does your organization come into contact with a person who is currently being trafficked, at risk of
trafficking, or has been trafficked?
1

Never

Occasionally

Frequently

Daily

33. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
34. Which of the following best describes your organization? (Mark all that apply.)










Academic institution
Anti-trafficking organization
Business/for-profit organization
Coalition/multidisciplinary team/task force
Federal government
Faith-based organization
State/local government
Nonprofit/community-based organization









OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/worker advocacy organization
Victim service provider
Other (please specify): _____________________

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 8 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SOAR ORGANIZATIONAL
LMS FEEDBACK FORM

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

35. Which of the following best describes the types of services your organization provides? (Mark all that apply.)











Behavioral health professional (e.g., psychologist,
psychiatrist, mental health/substance use counselor)
Child welfare (e.g., state agency staff, child welfare
contractor, nonprofit personnel)
Corrections-based services (e.g., parole, probation)
Criminal justice (e.g., law enforcement, prosecutor,
probation, court, forensic interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician assistant,
nurse practitioner, dentist, nurse, pharmacist)
Housing (e.g., case worker, shelter director, public
housing authority agencies)







Legal (e.g., immigration, civil and/or rights-based
attorney and/or paralegal, clinic)
Public health (e.g., licensure board, health
department staff, health care executive, community
health workers)
Social worker (e.g., case manager, school
counselor, supervisor, administrator)
Survivor empowerment, mentoring, or peer to peer
Violence prevention (e.g., child abuse and neglect;
elder abuse; domestic violence, sexual violence,
youth violence)
Other (please specify):
_______________________________

36. Which of the following best describes your organization’s geographic population? (Mark all that apply.)
□

□
□
□

National
State (please specify): ______________
Tribal
International (please specify country):
_________________________________

□
□
□
□

Local
Urban
Rural
Suburban

37. Please select any of the following populations your organization current works with in a professional capacity. (Mark all that
apply.)









Human trafficking
 Commercial sexual exploitation of
children
 Sex trafficking
 Adults
 Minors
 Labor trafficking
 Adults
 Minors
Children/youth
 Out of home/Foster care/Kinship care
 Juvenile justice
 Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning











Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
 American Indian or Alaska Native
 Asian
 Black or African American
 Native Hawaii or other Pacific Islander
 White
 Hispanic or Latino ethnicity
History of substance use
Intimate partner violence (e.g., dating, domestic
violence)
Gang-related crime
Sexual abuse/Violence
Other (please specify): __________________

38. Do you have any comments or suggestions for future SOAR-related trainings?

____________________________________________________________________________________
____________________________________________________________________________________
Thank you for taking the time to complete this form and helping to improve SOAR activities.
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 8 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol

______

Birth Month
(insert just the month
for your date of birth,
example: 08 for August)

First letter of first name
(example: S for Sara)

First letter of your middle name
(example: M for Maria)

Please rate the extent to which to you agree or disagree that the fellowship has helped your organization achieve the following
objectives.

FELLOWSHIP OBJECTIVES

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

The fellowship increased my organization’s
knowledge about trauma-informed practices.

The fellowship increased my organization’s skills
and knowledge about survivor-informed practices.

The fellowship increased the organization’s skills
and knowledge about current evidence-based
research and promising practices.

The fellowship increased the organization’s skills
and knowledge about a multidisciplinary approach to
addressing human trafficking.

The fellowship increased my organization’s skills
and knowledge on a public health response to human
trafficking.

The fellowship met my professional needs.

The fellowship met my educational needs.

My organization remained engaged in the fellowship
throughout its entirety.

[insert objective here].

10. [insert objective here].

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additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol
11. How were you invited to participate in this fellowship?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
12. Do you think NHTTAC should do anything differently when selecting organizations to participate in this fellowship?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Please indicate the extent to which you agree or disagree with the following statements about the Fellowship Activities:
Strongly
Disagree

Disagree

Agree

Strongly
Agree

13. The fellow was accommodating and flexible to work
with during the scheduling of the organizational audit.

14. My organization felt informed about the purposes of
the organizational audit prior to it occurring.

15. The organizational audit helped identify gaps in my
organization’s ability to address human trafficking.

16. The fellow and representatives from my organization
collaborated well during the organizational audit.

17. [insert objective].

18. [insert objective].

19. I would recommend keeping the organizational audit as
part of future survivor fellowships.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

20. The action plan was developed collaboratively between
my organization and the fellow.

21. The action plan we developed was adopted by senior
leadership in my organization.

22. The action plan we developed defined clear roles and
responsibilities.

23. The action plan we developed accounted for my
organization’s culture and structure.

24. The action steps we created were grounded in a
multidisciplinary approach to addressing human
trafficking.

ORGANIZATIONAL AUDIT

ACTION PLAN

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additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol

25. The action steps we created were grounded in a public
health approach to addressing human trafficking.

26. The action plan accounts for complex and multiple
traumas.

27. The action plan we created accounts for all types of
trafficking.

28. The action plan we created includes action steps to
address language and cultural barriers to serving at-risk
populations or potential victims of human trafficking.

29. I recommend keeping the action plan development as
part of future survivor fellowships.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

30. The customized training and technical assistance
(T/TA) provided by the fellow was well-organized.

31. The customized T/TA provided by the fellow was
detailed and thorough.

32. There was adequate time provided for the fellow to
conduct the customized T/TA to my organization.

33. There was adequate time provided for my organization
to receive the customized T/TA.

34. The customized T/TA helped my organization
implement best practices focused on trauma-informed
care and survivor empowerment.

35. I would recommend keeping the customized T/TA as
part of future survivor fellowships.

CUSTOMIZED T/TA

Please indicate the extent to which you agree or disagree with the following statements about your collaboration with the fellow:
Strongly
Disagree

Disagree

Agree

Strongly
Agree

36. The fellow was easy to communicate with throughout
fellowship activities.

37. The fellow was respectful throughout the process.

38. The fellow planned an appropriate amount of time to
help make an actionable change at my organization.

39. The fellow responded in a helpful manner to my
questions.

40. The fellow was helpful through remote communication.

41. The fellow created an open learning environment when
they visited in-person.

FELLOW:_____________________

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additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol
Please indicate the extent to which you agree or disagree with the following statements:
Strongly
Disagree

NHTTAC STAFF: __________________

Disagree

Agree

Strongly
Agree

Not Applicable

42. NHTTAC staff clearly articulated my organization’s
responsibilities in this fellowship.

43. NHTTAC set clear expectations for what to expect during
this fellowship.

44. NHTTAC provided me with necessary resources and
materials for this fellowship program.

45. NHTTAC staff were detail-oriented and thorough in the
planning of this fellowship.

46. NHTTAC was responsive to my organization’s questions
and needs.

47. NHTTAC provided my organization with additional
information on a public health approach to human
trafficking upon request.

48. My organization is satisfied with the overall support
provided by NHTTAC staff throughout the fellowship
program.

49. Is there anything additional NHTTAC could have done to support your organization during this fellowship?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
50. Please rate the overall quality of this fellowship program.
1

Poor

Fair

Good

Excellent

51. Overall, how well did this fellowship meet your expectations?
1
Far Below My
Expectations

2
Did Not Meet My
Expectations

3
Met My Expectations

4
Exceeded My
Expectations

52. How satisfied were you with the overall quality of the support you received from NHTTAC staff to help complete this
fellowship?
1

Very Dissatisfied

Dissatisfied

Satisfied

Very Satisfied

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number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol
53. Would you recommend NHTTAC to others to receive T/TA?

□ Yes

□ No

54. What are three things your organization plans to do as a result of this fellowship?

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
55. Was the format of this fellowship conducive to improving best practices at your organization? Why or why not?

________________________________________________________________________________
________________________________________________________________________________
59. As a result of participating in this fellowship program, does your organization plan to do any of the following? (Mark all
that apply.)
□ Change my management/leadership or
□ Begin a new project or initiative
interpersonal communication style
□ Develop/strengthen collaborative or strategic
□ Further develop skills and knowledge about serving
relationships
people who are currently being trafficked, at risk of
□ Network with other participants
trafficking, or have been trafficked
□ Share materials with colleagues
□ Write grants/fundraise/identify new funding
□ Provide information to clients/families/youth
resources
□ Train/educate others in content/skills learned
□ Advocate or meet with leadership of my
□ Raise public awareness/advocacy/outreach
organization to develop/enhance vision, mission, or
activities offered to people who are currently being
strategic plan
trafficked, at risk of trafficking, or have been
□ Advocate or meet with leadership of my
trafficked
organization to develop/enact policy changes at my
□ Refer colleagues to NHTTAC events/resources
organization
□ Conduct research
□ Improve programs/practices
□ Strengthen evaluation or needs assessment
□ Improve technology/websites/infrastructure
activities
□ Integrate victim-centered, survivor-informed
□ Improve identification and reporting methods for
strategies
trafficking
□ Expand services or types of services
□ Take additional training on human trafficking
□ Improve my own leadership or professional
□ Other (please specify): __________________
development skills
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number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol
60. Of the barriers listed below, which do you believe will be a significant challenge to performing the activities you selected
in the previous question? (Mark all that apply.)

□
□
□
□
□
□
□
□
□
□

Lack of senior leadership support
Lack of frontline support and accountability
Continuous turnover
Shortages of key personnel
Competing priorities
Inaccessible research and/or information
Lack of urgency
Lack of shared responsibility across
organizational collaboration
Lack of information sharing among
organizations
Lack of time to implement changes

□

Difficulty in establishing and/or maintaining a
multi-disciplinary team
Need for partnership building with other
organizations
Variation in mission and regulatory
frameworks when partnering with other
organizations
Lack of information and/or data sharing among
organizations
Lack of time to implement changes
Lack of training for staff in how to implement
change
Other (please explain): ________________

□
□
□
□
□
□

61. Which of the following best describes your organization? (Mark all that apply.)

□
□
□
□
□
□
□
□

Academic institution
Anti-trafficking organization
Business/For-profit organization
Coalition/Multidisciplinary team/Task force
Federal government
Faith-based organization
State and local government
Nonprofit/Community-based organization

□
□
□
□
□
□
□

OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/Worker advocacy organization
Victim service provider
Other, please specify: _____________________

62. Which of the following best describes the types of services your organization provides? (Mark all that apply.)








Behavioral health professional (e.g.,
psychologist, psychiatrist, mental
health/substance use counselor)
Child welfare (e.g., state agency staff, child
welfare contractor, nonprofit personnel)
Corrections-based services (e.g., parole,
probation)
Criminal justice (e.g., law enforcement,
prosecutor, probation, court, forensic interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician assistant,
nurse practitioner, dentist, nurse, pharmacist)

 Housing (e.g., case worker, shelter director, public
housing authority agencies)

 Legal (e.g., immigration, civil and/or rights-based






attorney and/or paralegal, clinic)
Public health (e.g., licensure board, health department
staff, health care executive, community health
workers)
Social worker (e.g., case manager, school counselor,
supervisor, administrator)
Survivor empowerment, mentoring, or peer to peer
Violence prevention (e.g., Child abuse and neglect;
elder abuse; domestic violence, sexual violence, youth
violence)
Other (please specify):
_______________________________

63. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes

□ No

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number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SURVIVOR FELLOWSHIP
FEEDBACK

OMB Control Number: 0970-XXXX
Expiration Date: XX/XX/XXXX

Organization Protocol
64. Which of the following best describes your organization’s geographic population? (Mark all that apply.)
□
□
□
□

National
State (please specify): ______________
Tribal
International (please specify country):
_________________________________

□ Local
□ Urban
□ Rural
□ Suburban

65. Please select any of the following populations does your organization currently work with in a professional capacity
(Mark all that apply.)

□

□
□
□
□

□

Human trafficking
□ Commercial sexual exploitation of
children
□ Sex trafficking
□ Adults
□ Minors
□ Labor trafficking
□ Adults
□ Minors
Children/youth
□ Out of home/Foster care/Kinship care
□ Juvenile justice
□ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning

□
□

□
□
□
□
□

Foreign nationals (migrant workers,
undocumented immigrants, refugees)
People with low incomes
Racial and ethnic minorities
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaii or other Pacific
Islander
□ White
□ Hispanic or Latino ethnicity
History of substance use
Domestic and dating violence
Gang-related crime
Sexual abuse/Violence
Other (Please specify): __________________

66. In your professional capacity, how frequently does your organization come into contact with a person who is currently
being trafficked, at risk of trafficking, or has been trafficked?
1

Never

Occasionally

Frequently

Daily

Thank you for taking the time to complete this form and helping to improve NHTTAC activities.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 15 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

File Type	application/pdf
Author	Field, Michael
File Modified	2018-07-06
File Created	2018-07-06