Download:
pdf |
pdfSOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
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].
PRETRAINING QUESTIONS:
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 rate your level of confidence in your ability to:
Very Low
Low
High
Very High
1.
Identify people who are at risk or have been trafficked
1
2
3
4
2.
Develop or redefine your vision and mission statements
1
2
3
4
3.
Serve individuals [at-risk of human trafficking] [recently out of a
trafficking situation] [who were trafficked in the past]
1
2
3
4
4.
Create a list of objectives for organizational change
1
2
3
4
5.
Identify the elements of an action-planning process
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
WEEKLY EVALUATION QUESTIONS:
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:
1.
2.
3.
4.
5.
6.
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
□ Yes
Did the instructor(s) provide feedback on the mastery of the learning objectives?
□ No
Please indicate the extent to which you agree or disagree with the following statements about the self-study materials for this
week:
7.
The materials addressed the learning objectives
clearly.
8. The materials addressed the critical issues related to
the topic(s).
9. The time allotted was adequate for the scope of the
self-study materials.
10. The content of the material was appropriate for my
level of experience and knowledge.
11. The materials increased my knowledge related to the
topics.
12. The materials increased my practical skills related to
the topics.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
13. I am satisfied with the overall quality of the
materials.
1
2
3
4
Please indicate the extent to which you agree or disagree with the following statements about the webinar for this week:
14. The webinar addressed the learning objectives
clearly.
15. The webinar addressed the critical issues related to
the topic(s).
16. The time allotted was adequate for the scope of
material covered.
17. The webinar was well organized and clear.
18. The material was appropriate for my level of
experience and knowledge.
19. The webinar increased my knowledge related to the
topics.
20. The webinar increased my practical skills related to
the topics.
21. I am satisfied with the overall quality of the webinar.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Please indicate the extent to which you agree or disagree with the following statements about each instructor:
Instructor 1:
22. The instructor demonstrated a comprehensive
knowledge of the subject.
23. The instructor presented the content clearly and
logically.
24. The instructor responded positively to questions and
comments.
25. The instructor created a respectful environment for
the participants.
Instructor 2:
26. The instructor demonstrated a comprehensive
knowledge of the subject.
27. The instructor presented the content clearly and
logically.
28. The instructor responded positively to questions and
comments.
29. The instructor created a respectful environment for
the participants.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
WEEK 4 (OR LAST WEEK OF TRAINING) EVALUATION QUESTIONS
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 rate your level of confidence in your ability to:
1.
Identify a person who is currently being trafficked, at
risk of trafficking, or has been trafficked.
Develop/redefine your vision and mission statements
Very Low
Low
High
Very High
1
2
3
4
1
2
3
4
Serve individuals [at risk of human trafficking]
[recently out of a trafficking situation] [who were
trafficked in the past]
1
2
3
4
4.
Create a list of objectives for organizational change
1
2
3
4
5.
Identify elements of an action-planning process
1
2
3
4
2.
3.
Please indicate the extent to which you agree or disagree with the following statements:
6.
7.
8.
9.
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
As a result of this week’s training activities, I .
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
Please indicate the extent to which you agree or disagree with the following statements about each instructor:
Instructor 1:
10. The instructor demonstrated a comprehensive
knowledge of the subject.
11. The instructor presented the content clearly and
logically.
12. The instructor responded positively to questions and
comments.
13. The instructor created a respectful environment for
the participants.
Instructor 2:
14. The instructor demonstrated a comprehensive
knowledge of the subject.
15. The instructor presented the content clearly and
logically.
16. The instructor responded positively to questions and
comments.
17. The instructor created a respectful environment for
the participants.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
□ Yes
18. Did the instructor(s) provide feedback on the mastery of the learning objectives?
□ No
Please indicate the extent to which you agree or disagree with the following statements about the self-study materials for this
week:
19. The materials addressed the learning objectives
clearly.
20. The materials addressed the critical issues related to
the topic(s).
21. The time allotted was adequate for the scope of the
self-study materials.
22. The content of the material was appropriate for my
level of experience and knowledge.
23. The materials increased my knowledge related to the
topics.
24. The materials increased my practical skills related to
the topics.
25. I am satisfied with the overall quality of the
materials.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
Please indicate the extent to which you agree or disagree with the following statements about the webinar for this week:
26. The webinar addressed the learning objectives
clearly.
27. The webinar addressed the critical issues related to
the topic(s).
28. The time allotted was adequate for the scope of
material covered.
29. The webinar was well organized and clear.
30. The material was appropriate for my level of
experience and knowledge.
31. The webinar increased my knowledge related to the
topics.
32. The webinar increased my practical skills related to
the topics.
33. I am satisfied with the overall quality of the webinar.
Strongly Disagree
Disagree
Agree
Strongly Agree
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
OVERALL TRAINING EVALUATION QUESTIONS (FOR LAST WEEK OF TRAINING OR DISSEMINATED 1
WEEK AFTER COMPLETION OF THE COURSE)
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)
For the next set of questions, please rate your responses based on the overall training:
1.
□
Did you receive continuing education credits for completing the training?
Yes
□
No
Please click the number that best represents your rating for this training for each of the following questions:
2.
3.
4.
5.
Please rate the overall quality of this training.
1
2
3
4
Poor
Fair
Good
Very Good
Please rate the overall quality of the webinar portion of this training.
1
2
3
4
Poor
Fair
Good
Very Good
Please rate the overall quality of readings, videos (excluding webinars), and worksheets used in this training.
1
2
3
4
Poor
Fair
Good
Very Good
Please rate how well the webinars and other weekly learning materials complemented each other.
1
2
3
4
Poor
Fair
Good
Very Good
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
Please indicate the extent to which you agree or disagree with the following statements:
Strongly Disagree
Disagree
Agree
Strongly Agree
I am confident that I will be able to use the
knowledge and skills I learned during the SOAR
training when I return to my job.
1
2
3
4
7.
The training met my educational needs.
1
2
3
4
8.
The training met my professional needs.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
17. The training was survivor informed.
1
2
3
4
18. The training was trauma informed.
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
6.
9.
The educational materials provided during this
training were useful.
10. The activities provided appropriate and effective
opportunities for active learning (case studies,
discussion, Q&A, etc.)
11. The time allotted was adequate for the scope of
material covered.
12. The technology was easy to use.
13. The use of technology provided a good learning
environment.
14. Overall, the instructors were knowledgeable about
the content.
15. As a result of this SOAR training, I can .
16. As a result of this SOAR training, I can .
19. The training was based on current evidence-based
research or promising practices.
20. The training reflects a public health approach to
addressing human trafficking.
21. The training will be useful for my practice or for my
professional development.
22. The training was grounded in a multidisciplinary
approach to addressing human trafficking.
23. The training provided ample opportunity and
encouragement for participants to meaningfully
interact with each other.
24. As a result of participating in this SOAR training, do you plan to do any of the following? (Mark all that apply.)
ϒ
ϒ
Change my
management/leadership or
interpersonal communication
style
Further develop skills and knowledge about
serving victims of trafficking
ϒ
ϒ
Write grants/fundraise/identify new funding
resources
Advocate or meet with leadership of my
organization to develop/enhance vision, mission, or
strategic plan
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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
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
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
Provide information to clients/families/youth
Train/educate others in content/skills learned
Raise public awareness/advocacy/outreach activities
offered to victims
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):
25. 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.)
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
ϒ
Difficulty in establishing and/or maintaining a
multidisciplinary team
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):
□
26. Would you recommend SOAR to others to receiving training?
Yes
□
No
27. What could be done differently to improve the training?
28. Which of the following best describes the organization in which you work? (Mark all that apply.)
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
Academic institution
Anti-trafficking organization
Business/for-profit organization
Coalition/multidisciplinary team/task force
Federal government
Faith-based organization
State/local government
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
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 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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
29. Which of the following best describes your professional capacity or types of services you provide? (Mark all that apply.)
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
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)
ϒ
ϒ
ϒ
ϒ
ϒ
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):
30. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at risk
of being trafficked, or has been trafficked?
1
2
3
4
Never
Occasionally
Frequently
Daily
31. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
32. Which of the following best describes the number of years of experience you have in your current field of work?
□
Less than 3 years
□
3–5 years
□
□
6–10 years
More than 10 years
33. Which of the following best describes your primary role in your current position?
□
□
□
Direct delivery/frontline staff
Management
Other (please specify):
□
□
□ Administration
□ Peer educator
Consultant/trainer
Volunteer
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 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 0.15 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.
SOAR BLENDED LEARNING
OMB Control Number: 0970-0519
PARTICIPANT FEEDBACK
Expiration Date: 05/31/2020
Form
35. Please select any of the following populations you currently work with in a professional capacity. (Mark all that apply.)
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
Human trafficking
ϒ Commercial sexual exploitation of
children
ϒ Sex trafficking
ϒ Adults
ϒ Minors
ϒ Labor trafficking
ϒ Adults
ϒ Minors
Children/youth
ϒ Out of home/Foster care/Kinship care
ϒ Juvenile justice
ϒ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
ϒ
Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
ϒ American Indian or Alaska Native
ϒ Asian
ϒ Black or African American
ϒ Native Hawaii or other Pacific Islander
ϒ White
ϒ 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):
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 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 0.15 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.
| File Type | application/pdf |
| File Title | 24 - SOAR Blended Learning Participant Feedback.docx |
| Author | Field, Michael |
| File Modified | 2020-03-20 |
| File Created | 2020-03-20 |