Monitoring Data for ECA (MODE) Framework

8/7/2020

Qualtrics Survey Software

Privacy Statement and Consent

Welcome to the ECA Alumni Survey!
The Evaluation Division of the U.S. State Department’s Bureau of Educational
and Cultural Affairs (ECA) would like to ask you a few questions about your
knowledge, attitudes, and future plans following your program experience.
operates in the community in which the program participant resides. Benefits to
this group
most often
occur through interaction
withsurvey
participantswill
and/or
alumniapproximately
this
survey
by [DEADLINE].
The
take
during or after an ECA sponsored program.

Please complete
[TIME ESTIMATE] minutes to complete.
Privacy Act Statement

AUTHORITY: The information on this form is requested under the authority of 22
U.S.C. 2451 et seq (Mutual Educational and Cultural Exchange Act of 1961), P.L.
103-62 (Government Performance and Results Act of 1993), and P.L. 111-352
(Government Performance and Results Modernization Act of 2010).
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PURPOSE: The purpose of gathering this information is to track program
performance and the direction, pace, and magnitude of change for ECA
programs.
ROUTINE USES: The information on this form may be shared with members of
Congress, and the Office of Management and Budget (OMB). De-identified data
files may be shared (without Personally Identifiable Information such as names or
contact information) with ECA implementing partners and external researchers
who are assisting ECA in measuring its impact. More information on the Routine
Uses for the system can be found in the System of Records Notice State-08,
Educational and Cultural Exchange Program Records.
DISCLOSURE: Responding to this survey is voluntary. The answers you provide
on the survey will have no bearing on your participation in alumni activities or any
future applications you may submit for U.S. State Department programs.
By clicking “Consent and Enter Survey” button below, you are consenting to the
above terms.
You can read ECA’s full data sharing and storage policy here: [LINK TO DATA
POLICY]

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Contact [email protected] for technical support with the survey system
or inquiries about specific questions in this survey.
Your progress will be saved each time you click the next button and you can
return to complete the survey in the same internet browser at any time. Thank you
in advance for your time and participation!
Consent and Enter Survey

Decline and End Survey

Program Questions

Please select any ECA programs from the list below that you have participated
in:
**To select multiple options, hold down Ctrl (on a PC) or Cmd (on a Mac) when clicking**

1000 Islands, 1000 Stories
ACCESS
AEIF
AFCP
Alien Physicians
Alumni Stories
Alumni Ties
American Arts Incubator
American Councils of Young Political Leaders (ACYPL)
American Film Showcase
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Please provide the following information for each program:
What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

1000 Islands, 1000 Stories

» ACCESS
» AEIF
» AFCP
» Alien Physicians
» Alumni Stories
» Alumni Ties
» American Arts Incubator
»

American Councils of
Young Political Leaders
(ACYPL)

»

American Film Showcase

» American Music Abroad
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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

An Empowerment and Civic
Participation Virtual
Exchange Series

»

Anti-Corruption Digital
Storytelling for Youth
Leaders in Ukraine

» Arts Envoy Program
» Au Pair
» Biennales
»

Building Capacity for Media
Literacy

» Camp Counselor
» CATF
» CBYX
» Center Stage
»

College and University
Students

» Comic Books Project

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

Community College
Administrator Program

»

Community College
Initiative Program

»

Community Solutions
Program

»

CongressBundestag/Bundesrat Staff
Exchange

»

Critical Language
Scholarship Program

» Dance Motion USA
» DCN
» EducationUSA
» EducationUSA Academy
»

EducationUSA Leadership
Institutes

»

English Language Fellows
and Specialists

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

» espnW
»

Federated States of
Micronesia: AFCP PD
Program

» FLEX
»

Fortune Women’s
Mentoring Partnership

»

From Start-Ups to Scale
Ups

» Fulbright Arctic Initiative
»

Fulbright Distinguished
Awards in Teaching
Program

»

Fulbright English Teaching
Assistant Program

»

Fulbright Foreign Language
Teaching Assistance
Program

»

Fulbright Foreign Student
Program

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

Fulbright Junior Faculty
Development Program

»

Fulbright Specialist
Program

»

Fulbright U.S. Scholar
Program

»

Fulbright U.S. Student
Program

»

Fulbright Visiting Scholar
Program

»

German-American
Partnership Program

»

Gilman International
Scholarship Program

» Global Media Makers
» Global UGRAD
»

GLOBE Citizens Science
Project

» Government Visitors
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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

» Humphrey Fellowship
»

Institute for Representative
Government

»

International Sports
Programming Initiative

» International Visitors
»

International Writing
Program

»

International Writing
Program for Eritrean
Creative Writers

» Interns
»

IVLP (including ondemand)

»

Japan-U.S. Friendship
Commission (CULCON)

»

Japan-U.S. Friendship
Commission (CULCON)

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

Journalist Virtual Exchange
Program

» MDAO
»

Media Literacy Training for
Journalists

»

Mike Mansfield Fellowship

»

Morocco: Cinemamathique
of Tangier Archive
Preservation

»

National Youth Science
Foundation

»

Native American Issues
Program

» Next Level
»

Ngwang Choepbel Fellows
Program

» NSLI-Y
» OneBeat
» Partners of the Americas
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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

PAS Implementation Plans
for YALI Alumni
Engagement

»

Professional Fellows
(including on-demand)

»

Professor and Research
Scholar

»

Promoting Human Rights
via Comics

»

Real Media Literacy in a
Fake News World

»

Science and Technology
Research Awardee
Exchange

» Short-term Scholar
» Solidarity Center (TPPP)
» Specialists
» Sport for Community
» Sports Envoy Program

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

» Sports Visitor Program
»

STEM Comic Book Project

» Stevens Initiative
» Student Secondary
»

Study Abroad CapacityBuilding

»

Study of the U.S. Institutes
for Scholars

»

Study of the U.S. Institutes
for Student Leaders

» Summer Work Travel
» Teacher
»

Teachers for Global
Classrooms

»

Teachers of Critical
Languages Program

»

Teaching Excellence and
Achievement Program
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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

» TechGirls
» TechWomen
»

The American English ETeacher Scholarship
Program

»

Tibetan Scholarship
Program

» TIP Storytelling Program
»

Towards Expo2020 Virtual
Exchange with Sister Cities
Dubai and Detroit

» Trainee
»

U.S. Congress ROK
National Assembly
Exchange Program

»

U.S. Exchange Alumni
Network and CapacityBuilding Program

»

U.S.- South Pacific
Scholarship Program

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

U.S.-Pakistan Professional
Partnership for Journalists
Program

»

U.S.-Timor Leste
Scholarship Program

»

WWI Liberation Exchange
Program

» YALI (MW Fellows)
» YES
» YES (U.S. Students)
» YLAI
» Youth Ambassadors
»

Youth Councils for Social
Entrepreneurship

» Youth Creative Camp
»

Youth Leadership Program

»

Youth Leadership Program
On Demand

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What year
did you start
your
program?

Did your exchange involve going abroad after having an individual
from another country your home school, or workplace as part of a
Department of State Exchange program?

»

Youth Podcasting for
Storytelling

» YSEALI

Unique Identifier Questions

The responses to the following five questions will be used to create a Respondent
Unique ID, which will be unique to you. We will use this unique ID to match your
responses across different surveys while maintaining your anonymity.

What is the first initial of your middle name?
**If you do not have a middle name, enter "X"**

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What are the first two letters of your mother's first name?
**If none or unknown, select "XX"**
Selection
First Letter
Second Letter

What are the first two letters of your father's first name?
**If none or unknown, select "XX"**
Selection
First Letter
Second Letter

What is the day of the month on which you were born as a 2-digit number? (e.g.
06, 12, 25)

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What are the last two digits of your birth year?

Demographic Questions

Please check the option that best describes your gender:
Male
Female
Non-Binary
I do not wish to respond

Please select the country of your citizenship at the time of your most recent
exchange:

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Other: Please enter your country of citizenship at the time of your most recent
exchange

U.S. Additional Demographics

Please select the State you were living in when you participated in your most
recent ECA program:

What is your race or ethnicity? (Select all the apply)
White
Hispanic or Latino
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
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Cross Cultural Competency (American)

The following questions will refer to your home or host community. As a
reminder, those terms are defined in the following way:
Home Community: A community in which you reside, or an institution that
operates in the community where you reside.
Host Community: A community or institution that spondored, supported, or
provided you program support or services related to your exchange. This can
include your host institution or family for
example. AA community in which the program participant resides, or an institution that
during or after an ECA sponsored program. community in which the program participant resides, or an institution that

How much did participation in the program change your understanding or
knowledge of the following topics?
No change

Minimal change

Moderate change

Substantial
change

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No change

Minimal change

Moderate change

Substantial
change

Host country political
system
Host country economy
Foreign affairs of my
host country
Domestic affairs of my
host country
Host country values and
culture
Daily life in my host
country
Religious and ethnic
diversity in my host
country
Freedom of speech and
press in my host country
Voluntary community
service in my host
country

Cross Cultural Competency (Foreign)

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How have you views of the United States Government and the American people
evolved since your program participation?

Less favorable

No change- My
view has
remained
unfavorable

No change- My
view has
remained
favorable

More favorable

United States
Government
American People

How much did participation in the program change your understanding or
knowledge of the following topics?
No change

Minimal change

Moderate change

Substantial
change

United States
democracy
United States economy
Foreign affairs in the
United States
Domestic affairs in the
United States
United States values
and culture
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No change

Minimal change

Moderate change

Substantial
change

Daily life in the United
States
Religious and ethnic
diversity in the United
States
Freedom of speech and
press in the United
States
Voluntary community
service in the United
States

Cultural Competency (American and Foreign)

Did your exchange include participants that were not from your home country or
host country?
Yes
No
I do not know

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Thinking about the exchange participants you met that were from other countries
(not your home country or your host country), how much did participation in the
program change your understanding or knowledge of the following topics related
to those countries?
No change

Minimal change

Moderate change

Substantial
change

Political system
Economy
Foreign affairs
Domestic affairs
Values and culture
Daily life
Religious and ethnic
diversity
Freedom of speech and
press
Voluntary community
service

To what extent do you agree or disagree with the statements below?
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Strongly
disagree

Disagree

Agree

Strongly
agree

Voting is important because real decisions are made in elections
Free and fair elections are the cornerstone of democracy
An independent media is important to the free flow of information
All citizens in a country should have equal rights and protections
under the law, regardless of circumstances
The rule of law is fundamental to a functioning democracy
Individuals and organizations have the right to free speech and to
voice position
Democratic principles enhance the workplace
Supervisors should incorporate democratic principles into their
management practices

Have you shared about your exchange experience in any of the following ways in
the past year?
Yes

No

Media interviews (newspaper, television, radio, podcast)
Presentations to community, neighborhood, school or university groups
Informal discussions with colleagues and other professionals
Informal discussions with family, friends, or community members
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Yes

No

Postings on electronic or social media (website, Facebook, Twitter, blog,
etc)
Newspapers or magazine articles, including editorials and opinion pieces

By sharing about my exchange experience, I have helped those in my community
better understand the United States.
Yes
No

By sharing about my exchange experience, I have helped those in my community
better understand my host country.
Yes
No

For the following questions, please consider the following statement:

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My responsibility to people of other countries is as great as my responsibility to
people of my own country.
Immediately following your program experience, what was your perspective on
the above statement?

Strongly
disagree

Disagree

Neutral

Agree

Strongly Agree I do not know

Today, as an ECA alum, has your perspective on the above statement changed?
Agree more

Remained the same

Agree less

I do not know

Civic Engagement (American and Foreign)

In the past 6 months, I have:

Often

Several
times

Once
or
twice

Never

Raised awareness on issues that affect my community or country
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Often

Several
times

Once
or
twice

Never

Volunteered in my local community

As a direct result of your participation in the exchange program, have you done
any of the following?
Yes

No

Organized or initiated new activities or projects in your organization
Introduced new policies or procedures in the workplace
Advocated for new initiatives in the workplace to support women
Advocated for new initiatives in the workplace to support underrepresented populations
Established joint ventures, organizational partnerships, or linkages
Introduced new curricula, teaching methods, or educational
standards

Other (Please specify)

In the past 6 months, I have:
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Often

Several
times

Once
or
twice

Never

Contacted media to express my concerns about an international
problem
Contacted media to express my concerns about a domestic
problem
Expressed my views about international politics on a website,
blog, or chat room
Expressed my views about domestic politics on a website, blog, or
chat room
Contacted or visited someone in government to seek public action
on international issues and concerns
Contacted or visited someone in government to seek public action
on domestic actions or concerns
Participated in an event where people express their views about
international problems
Participated in an event where people express their views about
domestic problems

As a result of your program participation, have you designed and implemented
any projects to help your community or country?
Yes
No
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Civic Engagement (No project)

What has prevented you from implementing a project?
I am not sure what to do
I have not had the time
I have not had the funding
I cannot get support from the appropriate stakeholders
My interests have shifted
Other (please specify)

Civic Engagement (Project Questions)

Did you access any of the following resources through the U.S. Embassy for your
project(s)? Select all that apply
Alumni Engagement Innovation Fund (AEIF)
Small Grants
American Spaces
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Supplies or equipment
Embassy network of experts and leaders
Other (please specify)
None

Which category below best describes your project(s)?
Youth engagement
Environment (Ex: sustainability, ecotourism, agriculture, etc)
Social entrepreneurship
Economic development
Leadership training
Education
Civic engagement
Promoting equality (Ex: interfaith dialogue, disability rights, women's empowerment)
Disinformation (Ex: information campaign, media literacy training)
Other (please specify)

Please select the main activities of your project:
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Trainings or workshops
Established an NGO or other organization
Mentorship program
Advocacy/awareness campaign
Events or speeches
Fundraising
Research
Other (please specify)

Civic Engagement (Foreign)

Do you ever post or submit your own news content, such as articles, videos, or
photos to a news outlet, listserv or social media group?
**News content includes articles, videos, photos, blogs and social media posts
that are intended to inform the public about current events either locally,
nationally, or globally)
Yes
No

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Please indicate approximately how many articles, videos, photos or posts you
have produced across the following platforms in the past 3 months:
Number
Local news outlet (TV, Radio, Print)
National news outlet (TV, Radio, Print)
International news outlet (TV, Radio, Print)
Blog
Social Media (Twitter, Instagram, Facebook,
SnapChat, WhatsApp)
Listserv

Understanding that false information is all around us, did you do either of the
following prior to your program participation?
Yes

No

Shared news or information that you LATER
FOUND OUT was made up?
Shared news and information that you KNEW AT
THE TIME was made up?

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What is the main reason you shared news and information that you knew at the
time was made-up?
I thought it was surprising or entertaining
I liked what it said
I wanted to create a discussion about it
I wanted to tell others it was inaccurate

Understanding that false information is all around us, did you do either of the
following since your program participation?
Yes

No

Shared news or information that you LATER
FOUND OUT was made up?
Shared news and information that you KNEW AT
THE TIME was made up?

What is the main reason you shared news and information that you knew at the
time was made-up?
I thought it was surprising or entertaining
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I liked what it said
I wanted to create a discussion about it
I wanted to tell others it was inaccurate

Civic Engagement (American and Foreign)

Please indicate the level to which you agree or disagree with the following
statements compared to the end of your program:

Agree more

My views
have not
changed, I
agree

My views
have not
changed, I
disagree

Disagree
more

If I am misinformed by the news media, it
is my own behavior that determines how
soon I will learn credible information
I am in control of the information I get
from the news media
The main thing that affects my
knowledge about the world is what I
myself do
If I pay attention to different sources of
news, I can avoid being misinformed
If I take the right actions I can stay
informed

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Did what you learned during your program on the issue of made-up news and
information lead you to do any of the following?
Yes

No

N/A

Stop getting news from a non-credible outlet
Check the facts of news stories yourself
Report or flag a story that you think is madeup
Change the way you use social media
Consume multiple news sources

Please briefly expand on the ways you have changed your media consumption.

Civic Engagement (Foreign 2)

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Please select how frequently you got your information from the following news
sources in the past month:
A lot

Some

Not too much

Not at all

International news organizations
National news organizations
Local news organizations
Friends, family, and acquaintances
Political figures or leaders
Social media sites, such as Facebook,
Twitter or Snapchat
Local newsletters or listservs

Please select which languages you primarily use to consume media in the past
month:
**To select multiple options, hold down Ctrl (on a PC) or Cmd (on a Mac) when
clicking**

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Acholi
Afrikaans
Akan
Albanian
Amharic
Arabic
Ashante
Asl
Assyrian
Azerbaijani

Please select how frequently you got your information from the following news
sources in the prior to program participation:
A lot

Some

Not too much

Not at all

International news organizations
National news organizations
Local news organizations
Friends, family, and acquaintances
Political figures or leaders
Social media sites, such as Facebook,
Twitter or Snapchat
Local newsletters or listservs

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Please select which languages you primarily use to consume media prior to
program participation:
**To select multiple options, hold down Ctrl (on a PC) or Cmd (on a Mac) when
clicking**
Acholi
Afrikaans
Akan
Albanian
Amharic
Arabic
Ashante
Asl
Assyrian
Azerbaijani

Capacity Building (American and Foreign)

As a result of your program participation, have you done any of the following?
Yes

No

Became an elected leader or been appointed to a regional or national
government position

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Yes

No

Introduced new ways of doing things at your workplace, academic institution,
or organization
Been officially recognized or received an award for any achievement
Begun planning to start a new NGO or new organization
Started an organization, NGO, or business
Become a leader within a student or civil society organization

Please explain why you were officially recognized or received the award.

Did your program participation help you do any of the following?
Yes

No

Get a new job
Gain more responsibilities in your current position
Receive a promotion
Receive a salary increase
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Yes

No

Expand your current business
Become a recognized subject matter expert in my field
Become a leader in my organization/community
Become involved in a professional organization

Has participating in this program given you leadership skills that are applicable to
your professional, academic, or civil pursuits?
Yes
No

During your program participation, did you learn another language (either formally
or informally)?
**To select multiple options, hold down Ctrl (on a PC) or Cmd (on a Mac) when
clicking**

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None
Acholi
Afrikaans
Akan
Albanian
Amharic
Arabic
Ashante
Asl
Assyrian

Capacity Building (Language)

Which of the following best describes your current ability to speak in the following
languages?

Able to
satisfy basic

Able to
satisfy

Able to
speak with
sufficient
grammatical
accuracy
and

Able to
speak

Proficie
equiva

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No
ability
at all

Able to
communicate
only in a very
limited
capacity

satisfy basic
survival
needs and
minimum
courtesy
requirements

satisfy
routine social
demands
and limited
work
requirements

and
vocabulary
to discuss
relevant
professional
areas

speak
fluently
and
accurately
in all
situations

equiva
to that
an
educa
nativ
speak

» None
» Acholi
» Afrikaans
» Akan
» Albanian
» Amharic
» Arabic
» Ashante
» Asl
» Assyrian
» Azerbaijani
» Azeri
» Bajuni
» Basque
» Behdini
» Belorussian
» Bengali
» Berber
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» Bosnian
» Bravanese
» Bulgarian
» Burmese
» Cakchiquel
» Cambodian
» Cantonese
» Catalan
» Chaldean
» Chamorro
» Chao-chow
» Chavacano
» Chin
» Chuukese
» Cree
» Croatian
» Czech
» Dakota
» Danish
» Dari
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» Dinka
» Diula
» Dutch
» Edo
» English
» Estonian
» Ewe
» Fante
» Farsi
» Fijian Hindi
» Finnish
» Flemish
» French
»

French
Canadian

» Fukienese
» Fula
» Fulani
» Fuzhou
» Ga
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» Gaddang
» Gaelic
» Gaelic-irish
»

Gaelic-scottish

» Georgian
» German
» Gorani
» Greek
» Gujarati
»

Haitian Creole

» Hakka
»

Hakka-chinese

» Hausa
» Hebrew
» Hindi
» Hmong
» Hungarian
» Ibanag
» Ibo
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» Icelandic
» Igbo
» Ilocano
» Indonesian
» Inuktitut
» Italian
» Jakartanese
» Japanese
» Javanese
» Kanjobal
» Karen
» Karenni
» Kashmiri
» Kazakh
» Kikuyu
» Kinyarwanda
» Kirundi
» Korean
» Kosovan
» Kotokoli
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» Krio
» Kurdish
» Kurmanji
» Kyrgyz
» Lakota
» Laotian
» Latvian
» Lingala
» Lithuanian
» Luganda
» Luo
» Maay
» Macedonian
» Malay
» Malayalam
» Maltese
» Mandarin
» Mandingo
» Mandinka
» Marathi
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» Marshallese
» Mien
» Mina
» Mirpuri
» Mixteco
» Moldavan
» Mongolian
» Montenegrin
» Navajo
» Neapolitan
» Nepali
»

Nigerian Pidgin

» Norwegian
» Oromo
» Pahari
» Papago
» Papiamento
» Pashto
» Patois
»

Pid i E

li h

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Pidgin English

» Polish
» Portug.creole
» Portuguese
» Pothwari
» Pulaar
» Punjabi
» Putian
» Quichua
» Romanian
» Russian
» Samoan
» Serbian
»

Shanghainese

» Shona
» Sichuan
» Sicilian
» Sinhalese
» Slovak
» Somali
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» Sorani
» Spanish
»

Sudanese
Arabic

» Sundanese
» Susu
» Swahili
» Swedish
» Sylhetti
» Tagalog
» Taiwanese
» Tajik
» Tamil
» Telugu
» Thai
» Tibetan
» Tigre
» Tigrinya
» Toishanese
» Tongan
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» Toucouleur
» Trique
» Tshiluba
» Turkish
» Twi
» Ukrainian
» Urdu
» Uyghur
» Uzbek
» Vietnamese
» Visayan
» Welsh
» Wolof
» Yiddish
» Yoruba
» Yupik

Have you used the language skills to advance in any of the following areas?
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Career
Education
Community work (volunteerism)
Civil society work
Other area (please specify)
None of these areas

Capacity Building (American and Foreign)

Did you increase any of the following skills as a result of participating in this
program? Please select all that apply.
Project management skills
Entrepreneurship skills
Journalism skills
Teaching instruction skills
Science skills
Technology skills
Engineering skills
Mathematics skills
Other technical skill (please specify)

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No skills improvement

Have you used any of the following skills gained as a result of participating in an
ECA program to advance your career, studies, or work in civil society? Please
select all that apply.
I have not used any skills gained

» Project management skills
» Entrepreneurship skills
» Journalism skills
» Teaching instruction skills
» Science skills
» Technology skills
» Engineering skills
» Mathematics skills
» Other technical skill (please specify)
» No skills improvement

Networking (American)

Are you still in contact with the following?
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Personally in
contact

Professionally
in contact

Both
personally
and
professionally
in contact

Not in
contact at all

N/A – I did
not make
contact at all

Host country friends
Host country academic
colleagues
Host country
professional colleagues
Other program
participants from the
United States
Program host family
U.S. Embassy

Have you pursued any of the following collaboration activities as a direct result of
your program experience?
Yes

No

Professionally collaborated with alumni from the United States that I met during the program

Professionally collaborated with contacts from my host country that I met during the program
Professionally collaborated with alumni from other programs or cohorts that I met through alumni
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activities

Yes

No

Received advice or mentorship from alumni from the United States that I met during the program
Received advice or mentorship from contacts from my host country that I met during the program

Networking (Foreign)

Are you still in contact with the following?

Personally in
contact

Professionally
in contact

Both
personally
and
professionally
in contact

Not in
contact at all

N/A – I did
not make
contact at all

American friends
American academic
colleagues
American professional
colleagues
Other program
participants from my
country
Other program
participants from my
region

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Personally in
contact

Professionally
in contact

Both
personally
and
professionally
in contact

Not in
contact at all

N/A – I did
not make
contact at all

Other program
participants from
outside my region
Program host family
U.S. Embassy

Have you pursued any of the following collaboration activities as a direct result of
your program experience?
Yes

No

Professionally collaborated with alumni from my country that I met during the program
Professionally collaborated with alumni from another country that I met during the program
Professionally collaborated with Americans that I met during the program
Professionally collaborated with alumni from other programs or cohorts that I met through
alumni activities
Received advice or mentorship from alumni from my country that I met during the program
Received advice or mentorship from alumni from another country that I met during the
program
Received advice or mentorship from Americans that I met during the program
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Networking (American and Foreign)

Are you registered on the following websites?
Yes

No

I do not know

International Exchange Alumni
Network
Program Facebook page
Program WhatsApp group
Other (please specify)

Have you received the International Exchange Newsletter?
Yes
No
I do not know

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Have you used any of the following resources?
Yes

No

Small grants applications for the U.S. Government
AEIF applications
Contact information for other alumni
Project Development toolkits
Information on workshops/events hosted by the Embassy

Do you consider yourself an alumni of a U.S. Department of State program?
Yes
No

Networking (Foreign 2)

Have you participated in an event or activity after your program that the U.S.
Embassy hosted or organized?
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Yes
No

Since your exchange experience have you returned to the United States for any
of the following reasons?
Yes

No

Make money/work
Continue education
Participate in another ECA exchange
program
Tourism/visit friends/family
Other (please specify)

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OMB Control Number: 1405-XXXX
Burden Es mate: 30 minutes
Expira on Date: XX-XX-XXXX

PRA Statement
Public repor ng burden for this collec on of informa on is es mated to average 30 minutes per
response, including me required for searching exis ng data sources, gathering the necessary
documenta on, providing the informa on and/or documents required, and reviewing the final
collec on. You do not have to supply this informa on unless this collec on displays a currently valid
OMB control number. If you have comments on the accuracy of this burden es mate and/or
recommenda ons for reducing it, please send them to: [email protected].

Contact [email protected] for technical support

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