Specialized T/TA Feedback Form

NHTTAC Consultant and Evaluation Package

11 - Specialized TTA Feedback

Specialized T/TA Feedback Form

OMB: 0970-0519

⚠️ Notice: This form may be outdated.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

2023-03-24 - Revision of a currently approved collection

Document [pdf]

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SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

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
(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)

T/TA:

DATE(S):

CONSULTANT FACILITATOR(S):
NHTTAC COORDINATOR:

Please indicate how well the training met each stated objective.

OVERALL OBJECTIVES

Poor

Fair

Good

Excellent

[Insert objective 1].

[Insert objective 2].

[Insert objective 3].

[Insert objective 4].

[Insert objective 5].

Please list any other professional goals you have achieved through this T/TA.

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

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

FACILITATOR 1:

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

The facilitator demonstrated a comprehensive knowledge of
the subject.

The facilitator clearly and logically presented the content.

The facilitator responded well to questions and comments.

10. The facilitator created a respectful environment for
participants.

11. The facilitator encouraged and initiated helpful discussions.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

12. The facilitator demonstrated a comprehensive knowledge of
the subject.

13. The facilitator clearly and logically presented the content.

FACILITATOR 2:

14. The facilitator responded well to questions and comments.

15. The facilitator created a respectful environment for
participants.

16. The facilitator encouraged and initiated helpful discussions.

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

17. The T/TA reflected a public health approach to addressing
human trafficking.

18. The T/TA helped me identify potential language and cultural
barriers my organization might face in responding to human
trafficking.

19. The T/TA was trauma informed.

20. The T/TA was survivor informed.

21. The T/TA was grounded in a multidisciplinary approach to
addressing human trafficking.

22. The T/TA included evidence-based research or promising
practices.

23. The T/TA will positively impact my organization’s response
to human trafficking.

24. This T/TA met my educational needs.

25. This T/TA met my professional needs.

26. This T/TA changed [my/my organization’s] attitudes on
trauma-informed approaches to addressing trafficking

27. This T/TA increased my professional networking or peer
support

28. This T/TA increased knowledge to inform a human
trafficking public health response.

OVERALL FEEDBACK

NA
NA

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

29. [insert T/TA activity objective].

30. [insert T/TA activity objective].

31. [insert T/TA activity objective].

32. [insert T/TA activity objective].

33. [insert T/TA activity objective].

34. [insert T/TA activity objective].

35. [insert T/TA activity objective].

36. [insert T/TA activity objective].

37. [insert T/TA activity objective]

38. [insert T/TA activity objective].

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Not
Applicable

39. NHTTAC was responsive to my questions and needs.

40. NHTTAC was effective in identifying an appropriate grantee
to help with our request.

41. NHTTAC staff was detail-oriented and thorough in the
planning of this T/TA.

42. NHTTAC was timely throughout the planning process.

43. The planning for this T/TA was well coordinated.

T/TA ACTIVITY:

PLANNING

44. Please rate the overall quality of this T/TA.
1

Poor

Fair

Good

Excellent

45. How satisfied were you with your overall NHTTAC experience?
1

Very Dissatisfied

Dissatisfied

Satisfied

Very Satisfied

3
Met My
Expectations

4
Exceeded My
Expectations

46. How well did this assistance meet your expectations?
1
Far Below My
Expectations

2
Did Not Meet My
Expectations

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

47. How responsive was NHTTAC to your needs following the T/TA?
1
Completely
Unresponsive

Unresponsive

Responsive

Very Responsive
□ Yes

48. Would you recommend NHTTAC to others to receive T/TA?

□ No

49. What are three things you plan to do as a result of this T/TA?

50. Following this T/TA, how prepared do you feel to take steps toward addressing human trafficking in your organization?
1

Not At All Prepared

Somewhat Prepared

Mostly Prepared

Completely Prepared

51. What could NHTTAC do in the future to enhance your level of preparedness during this type of T/TA?

52. What could NHTTAC do in the future to enhance your level of preparedness following this type of T/TA?

53. What aspects of the T/TA were most helpful and why?

54. What could NHTTAC do differently to improve similar T/TA requests in the future?

55. Do you have any other comments or suggestions?

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

56. 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

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

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

□ No

58. Which of the following best describes your professional capacity or types of services you provide? (Mark all that
apply.)
ϒ Behavioral health professional (e.g., psychologist,
ϒ Legal (e.g., immigration, civil and/or rights-based
psychiatrist, mental health/substance use counselor)
attorney and/or paralegal, clinic)
ϒ Child welfare (e.g., state agency staff, child welfare
ϒ Public health (e.g., licensure board, health
contractor, nonprofit personnel)
department staff, health care executive, community
health
workers)
ϒ Corrections-based services (e.g., parole, probation)
ϒ Social worker (e.g., case manager, school
ϒ Criminal justice (e.g., law enforcement, prosecutor,
counselor, supervisor, administrator)
probation, court, forensic interviewer)
ϒ
Survivor empowerment, mentoring, or peer to peer
ϒ Educator (e.g., teacher, professor, school
administrator)
ϒ Violence prevention (e.g., Child abuse and neglect;
elder abuse; domestic violence, sexual violence,
ϒ Health care (e.g., physician, physician assistant,
youth violence)
nurse practitioner, dentist, nurse, pharmacist)
ϒ
Other
(please specify):
ϒ Housing (e.g., case worker, shelter director, public
housing authority agencies)
59. 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

60. Which of the following best describes your primary role in your current position?
□ Direct delivery/frontline staff
□ Management
□ Other (please specify):

□ Consultant/Trainer
□ Volunteer
□ Peer Educator

□ Administration

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

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

Never

Occasionally

Frequently

Daily

62. 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

63. 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):

64. 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):

SPECIALIZED TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
Form

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

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

□
□
□

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

66. 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.

File Type	application/pdf
File Title	11 - Specialized TTA Feedback.docx
Author	Field, Michael
File Modified	2020-03-20
File Created	2020-03-20