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Instructions for Award Recipients:
Instructions for Award Recipients: Participants should receive the survey no
sooner than xxx and no later than 6 weeks after an activity has ended.
Introduction and Consent Language:
Introduction and Consent Language:
Consent language should meet the following guidelines:
State how long the data collection is expected to take
Explain the purpose of the data collection
Explain how data will be used, shared, and stored
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Specify that participation in data collection is voluntary and will have no
consequences to the respondent
Provide contact information for questions or technical support
Unique ID
The responses to the following four 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.
What are the first two letters of your mother’s first name?
What are the first two letters of your father’s first name?
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What is your gender?
Female
Male
Non-Binary
What are the last two digits of your birth year?
Disaggregation Questions
Please check the option that best describes your gender
Male
Female
Non-binary
I do not with to respond
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Please enter your age
Please select your home state:
What is your race or ethnicity? Mark one or more.
White
Hispanic or Latino
Black or African American
Asian
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Please select the country of your citizenship:
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Cross Cultural Competency
Before this exchange program, did you travel outside of your home country?
Yes
No
Why did you travel outside of your home country [select all that apply]:
Tourism
Visit friends/family
Participation in another ECA exchange program
Study
Work
Other
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Before this exchange program, did you travel to the United States?
Yes
No
Why did you travel to the United States [select all that apply]:
Tourism
Visit friends/family
Participation in another ECA exchange program
Study
Work
Other
My exchange program’s activities offered opportunities for cultural connectedness
and sharing. For example: Conversations about each other’s’ countries, attending
cultural events, etc.
Yes
No
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How did your views of the United States government and the American people
change as a result of your program participation?
Less favorable
No change – my
view remained
unfavorable
throughout
No change – my
view remained
favorable
throughout
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
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No change
Minimal change
Moderate change
Substantial
change
United States values
and culture
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 in
the United States
How much did participation in the program change your understanding or
knowledge of the following topics?
No change
Minimal change
Moderate change
Substantial
change
Host country political
system
Host country economy
Foreign affairs of my
host country
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No change
Minimal change
Moderate change
Substantial
change
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
Thinking about the exchange participants you met that were from other countries
(not your home country or the U.S.), 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
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No change
Minimal change
Moderate change
Substantial
change
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?
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
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Strongly disagree
Disagree
Agree
Strongly agree
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
Individuals and
organizations have the
right to free speech and
to voice opposition
Democratic principles
enhance the workplace.
Supervisors should
incorporate democratic
principles into their
management practices
Compared to before your program participation, how likely are you to recommend
the U.S. as a good place to study?
Less likely to recommend
No change – I was never likely to recommend
No change – I was always likely to recommend
More likely to recommend
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Civic Engagement
Did you volunteer your time during your exchange?
Yes
No
My program did not offer the opportunity to volunteer
How many hours did you spend volunteering your time during your exchange?
(Please note that volunteer hours do not include time spend working as part of
your professional placement)
As a result of your program participation, has your confidence in the following
statements changed?
Increased
Stayed the same
Decreased
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Increased
Stayed the same
Decreased
I know several ways in
which I can make a
difference on some of
society’s most
worrisome problems.
I feel I have the ability to
make a difference in my
local community.
I feel I have the ability to
make a difference in the
global community
Networking
Do you consider yourself an alumni of a U.S. Department of State program?
Yes
No
Because of your participation in the program, have you increased the number of
Americans you are professionally or personally connected with?
Yes
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No
I have ________________ the number of Americans I am connected with.
Have you increased the number of individuals from a country other than your own
or the United States that you are personally or professionally connected with?
Yes
No
I have ________________ the number of persons I am connected with who are
from a country other than my own or where the exchange took place
Are you registered on the following websites?
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Yes
No
Do Not Know
International Exchange Alumni
Network
Program Facebook page
Program WhatsApp group
Other:
Through your program experience, did you learn about any new resources that
will be useful to you in the future (either personally or professionally)?
Yes
No
Please select the appropriate response for each resource:
I did not know
this was a
resource
I know this
resource
exists but do
not know
where to find
it
I know where
to find this
resource and
have used it
I know where
to find this
resource but
have not used
it
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I did not know
this was a
resource
I know this
resource
exists but do
not know
where to find
it
I know where
to find this
resource and
have used it
I know where
to find this
resource but
have not used
it
Small grants applications
AEIF applications
Contact information for other alumni
Project Development tool kits
Information on workshops/ events
hosted by the Embassy
Other Resource:
Capacity Building
Has participating in this program increased your job skills (including language
proficiency)?
Yes
No
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Do you feel that you have increased your skill level in any of the following areas
as a result of participation in this program? Please select all that apply.
Communication skills
Listening skills
Self-awareness
Awareness of others
Self-initiative
Self-confidence
Resourcefulness
Decision-making skills
Problem-solving skills
No skills improvement
Which of the following best describes your ability to speak in a second
language?
No ability at all
Able to communicate only in a very limited capacity
Able to satisfy basic survival needs and minimum courtesy requirements
Able to satisfy routine social demands and limited work requirements
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Able to speak with sufficient grammatical accuracy and vocabulary to discuss relevant
professional areas
Able to speak fluently and accurately in all situations
Proficiency equivalent to that of an educated native speaker
Please indicate the level to which you agree or disagree with the following
statements:
Agree more
Remained the
same, I agree
Remained the
same, I disagree
Agree less
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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Economic Development
In the past [TIMEFRAME], how much money have you spent on food, travel,
leisure, and merchandise that was purchased in the United States?
$100 or less
$101 - $300
$301 - $500
$501 - $1,000
$1001 or more
OMB Control Number: 1405-XXXX
Burden Es mate: 8 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
8 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].
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| File Type | application/pdf |
| File Modified | 2020-08-11 |
| File Created | 2020-08-11 |