Form 10 Process Evaluation Participant Survey

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

YOUR EXPERIENCE IN THIS COURSE

The next questions ask about your experience in the course you just completed.

34. Think about the course you just completed. How satisfied or dissatisfied are you with…?

SELECT ONE ANSWER FOR EACH ROW	Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
a. The course overall
b. The instructor
c. The course activities
d. The course content

35. How much did this course interest or engage you?

SELECT ONE ANSWER

Not at all

Very little

Somewhat

Quite a bit

A lot

36. How comfortable did you feel talking or sharing your thoughts in the course?

SELECT ONE ANSWER

Very uncomfortable

Uncomfortable

Neither comfortable nor uncomfortable

Comfortable

Very comfortable

37. How comfortable did you feel participating in the course activities (such as exercises, games, or role playing)?

SELECT ONE ANSWER

Very uncomfortable

Uncomfortable

Neither comfortable nor uncomfortable

Comfortable

Very comfortable

38. Now think about the instructor (the person who taught the lessons). Mark how much you agree or disagree with the following statements.

SELECT ONE ANSWER FOR EACH ROW	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
a. The way the instructor presented the material helped me to understand it.
b. The instructor understands students my age.
c. The instructor knows a lot about life.
d. The instructor knows a lot about the course material.
e. I felt I could trust the instructor.
f. I felt respected by the instructor.
g. The instructor cares about youth like me.
h. The instructor did a good job answering students’ questions.
i. The instructor seemed nervous.
j. The instructor was enthusiastic about teaching the course.

39. Mark how much you agree or disagree with the following statements.

SELECT ONE ANSWER FOR EACH ROW	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
a. The activities we did in the course helped me understand the course material.
b. The course materials were easy to read and understand.
c. We rushed through some of the topics.
d. Some of the topics dragged on for a long time.
e. I will be able to use the information and skills I learned in the course.
f. Because of this course, I feel more comfortable talking to my parent(s) or guardian(s) about sex.
g. Because of this course, I feel more comfortable talking to my parent(s) or guardian(s) about romantic relationships.
h. What I learned in this course makes me feel like I should be having sex.
i. The topics in this course were appropriate for people my age.

40. How helpful or unhelpful was each of the following activities in the course?

SELECT ONE ANSWER FOR EACH ROW	Very unhelpful	Unhelpful	Neither helpful nor unhelpful	Helpful	Very helpful	Not relevant – was not part of the course
a. Lecture
b Video
c. Role playing
d. Small group discussion
e. Homework
f. Guest speakers

41. How important is it that these topics be taught to teens?

SELECT ONE ANSWER FOR EACH ROW	Not at all important	Slightly important	Moderately important	Very important	Extremely important
a. Adolescent development and sexual health
b. Information about STDs/STIs
c. How effective different types of contraception are
d. How to use contraception
e. How to have a healthy romantic relationship
f. Information about sexual assault or sexual abuse
g. Resisting pressure to have sex from friends or the media
h. How to say “no” to sex even if it means losing a relationship
i. How to wait until marriage to have sex
j. How to avoid situations that might lead to having sex
k. How alcohol impairs judgment, especially about sexual activity
l. How to set goals for my future
m. How to have a good marriage
n. How to talk to parent(s) or guardian(s) about romantic relationships
o. How to talk to parent(s) or guardian(s) about sex

42. Since you started this course, have you talked about the topics covered in the course with any other student(s) at your school who have not taken the course?

SELECT ONE ANSWER

Yes

No

Don’t know

43. Since you started this course, have you talked about the course with your parent(s) or guardian(s)?

SELECT ONE ANSWER

Yes  GO TO 44

No  SKIP to 45

44. What were your parent(s)’ or guardian(s)’ views on the course?

SELECT ONE ANSWER

Very negative

Negative

Mix of positive and negative

Positive

Very positive

They did not share their views

45. Has your definition of “sexual intercourse” changed after taking this course?

SELECT ONE ANSWER

Yes, I think “sexual intercourse” includes more behaviors after taking this course

Yes, I think “sexual intercourse” includes fewer behaviors after taking this course

No, my definition of “sexual intercourse” is the same as it was before taking this course

46. After taking this course, are you more or less likely to have sexual intercourse in the next 12 months?

SELECT ONE ANSWER

More likely to have sexual intercourse in the next 12 months

Less likely to have sexual intercourse in the next 12 months

Neither more nor less likely to have sexual intercourse in the next 12 months (no change)

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