U.S. Community Members Survey

Evaluation of the Mandela Washington Fellowship for Young African Leaders

US Community Member Survey Screenshots

U.S. Community Members Survey

OMB: 1405-0235

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Evaluation of the Mandela Washington Fellowship for Young African Leaders

U.S. Community Member Survey

Screenshots of Survey Questions in Qualtrics Platform



Link to survey: https://bit.ly/2VbhZWo

Note: The screenshots below show the mobile view of the U.S. Community Member survey. Surveys can be taken either via mobile device or on a desktop. To view the desktop version of the survey, please visit the link above.









  • If “I consent to participate in this survey” is selected, proceed to first survey question

  • If “I do not consent to participate in this survey” is selected, survey will close











  • Each selection will prompt specific questions based on the selected role.

    • See pages 12 – 22 for Academic and Leadership Institute Professional/Peer Collaborator Questions

    • See pages 23 – 33 for Home Stay Host questions

    • See pages 34 – 41 for Community Partner questions

    • See pages X – X for Community Service Organization questions













  • If “Yes” is selected, a follow-up question will appear on the next page (see page 17)



  • If “Yes” is selected, a follow-up question will appear on the next page (see page 19)





  • If “Yes” is selected, additional questions appear on next page (see page 21)

  • If “No” is selected, the branch ends.









  • Selections in this question (e.g., 2014, 2015) will be carried forward to the next question (see page 25)







  • If “Yes” selected, a follow-up question appears on the next page (see page 28)



  • If “Yes” is selected, a follow-up question will appear on the next page (see page 30)



  • If “Yes” is selected, follow-up questions will appear on the next page (see page 32)













  • If “Yes” is selected, follow-up questions will appear on the next page (see page 40)









  • If “Yes” is selected, follow-up questions will appear on the next page (see page 47)



  • If “Yes” is selected, follow-up questions will appear on the next page (see page 49)

  • If “Yes” is selected, follow-up questions will appear on the next page (see page 51)































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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCynthia Rathinasamy
File Modified0000-00-00
File Created2021-01-15

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