Follow-up Feedback Form

FOLLOW-UP
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 to learn about your experiences since receiving training and technical assistance (T/TA)
[insert time frame] ago. 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].
T/TA
DATE(S):

Please provide the information below to create an anonymous ID:

Birth Month

First letter of first name

First letter of your middle name

(insert just the month

(example: S for Sara)

(example: M for Maria)

for your date of birth:
08 for August)
Please indicate the extent to which you agree or disagree with the following statements:

As a result of [insert T/TA], I have…
1.
2.
3.
4.
5.
6.

Strongly Disagree

Disagree

Agree

Strongly Agree

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

As a result of participating in [insert T/TA], have you done any of the following? (Mark all that apply.)
ϒ Improved programs/practices
ϒ Changed my management/leadership
ϒ Improved technology/websites/infrastructure
or interpersonal communication style
ϒ Integrated victim-centered, survivor-informed
ϒ Further developed skills and knowledge
strategies
about serving victims of trafficking
ϒ Expanded services or types of services
ϒ Wrote grants/fundraised/identified new
ϒ Began a new project or initiative
funding resources
ϒ Developed/strengthened collaborative or strategic
ϒ Advocated or met with leadership of my
relationships
organization to develop/enhance vision, mission,
ϒ
Networked with other participants
or strategic plan
ϒ Shared materials with colleagues
ϒ Advocated or met with leadership of my
ϒ Provided information to clients/families/youth
organization to develop/enact policy changes at
my organization
ϒ Trained/educated others in content/skills learned

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 0.133 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.

FOLLOW-UP
FEEDBACK
Form
ϒ
ϒ
ϒ
ϒ

7.

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

ϒ

Raised public
awareness/advocacy/outreach activities
offered to victims
Referred colleagues to NHTTAC events/resources
Conducted research
Strengthened evaluation or needs assessment
activities

ϒ
ϒ

Improved identification and reporting methods for
trafficking
Took additional training on human trafficking
Other (please specify):

Since [insert T/TA], what barriers have you faced in implementing change? (Mark all that apply.)
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ

ϒ

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

ϒ
ϒ
ϒ
ϒ
ϒ

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

Please indicate the extent to which you have used the following in your daily work
Never

Occasionally

Frequently

Daily

8.

1

2

3

4

9.

1

2

3

4

10.

1

2

3

4

11.

1

2

3

4

12.

1

2

3

4

13.

1

2

3

4

14.

1

2

3

4

15.

1

2

3

4

16.

1

2

3

4

17. Was there anything not provided during [insert T/TA] that would have been helpful in implementing change?

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 0.133 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.

FOLLOW-UP
FEEDBACK
Form

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

18. What aspect(s) of [insert T/TA] were most helpful to you?

□

19. Would you recommend [NHTTAC][SOAR] T/TA to others?

Yes

□

No

20. Do you have any additional comments or suggestions for future [NHTTAC][SOAR]-related T/TA?

21. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
22. In your professional capacity, how frequently do you come into contact with a person who is being trafficked, at risk
of being trafficked, or has been trafficked?

1

2

3

4

Never

Occasionally

Frequently

Daily

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

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 0.133 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.