Instrument 2b_PREP High School Participant Exit Survey

Personal Responsibility Education Program (PREP) Performance Measures and Adulthood Preparation Subjects (PMAPS)

Instrument 2b_PREP High School Participant Exit Survey

OMB: 0970-0497

Document [docx]
Download: docx | pdf


INSTRUMENT 2

prep participant Exit Survey

high school and older




Form approved

OMB Control No: 0970-0497

Expiration Date: XX/XX/XXXX



PERSONAL RESPONSIBILITY EDUCATION PROGRAM (PREP)

Shape2

PARTICIPANT EXIT SURVEY

HIGH SCHOOL AND OLDER


Thank you for your help with this important study. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your name will not be on the survey and your responses will remain private to the extent permitted by law. We want you to know that:

1. Your participation in this survey is voluntary.

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The information collected will help policy makers, program providers and other stakeholders understand the experiences of youth today and identify ways to reduce risky behaviors. This information will also inform programs on how best to serve their participants. The collection of this information is voluntary and responses will be kept private to the extent allowed by law. The OMB number for this information collection is 0970-0497and the expiration date is XX/XX/XXXX.

2. We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer.

3. The answers you give will be kept private to the extent permitted by law.

General Instructions


PLEASE READ EACH QUESTION CAREFULLY: There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Here are some examples.

  • PLEASE MARK ALL ANSWERS WITHIN THE WHITE BOXES PROVIDED.

  • USE A PEN OR PENCIL.


1. EXAMPLE 1: MARK ONLY ONE ANSWER

What is the color of your eyes?

MARK ONLY ONE ANSWER

Shape5 Shape4

If the color of your eyes is brown, you would mark (X) the first box as shown.

X

Brown

Shape6

Blue

Shape7

Green

Shape8

Another color

2. EXAMPLE 2: MARK ALL THAT APPLY

Do you plan to do any of the following next week?

Shape9

If you plan to watch a movie and go to a baseball game next week, you would mark (X) both boxes.

MARK ALL THAT APPLY

Shape10

X

Watch a movie

Shape11

X

Go to a baseball game

Shape12

Study at a friend’s house



Shape13 Shape14

  • Because you answered “Yes” to question 1, you would continue to question 2 and then question 3.

  • If you answered “No” to question 1, you would skip question 2 and go right to question 3.

  • 1.

3. EXAMPLE 3: QUESTION WITH A SKIP

Do you ever eat chocolate?

MARK (X) ONE

Shape16 Shape15

X

Shape17 Yes GO TO QUESTION 2

Shape18

No GO TO QUESTION 3

Shape19

2.

Do you always brush your teeth after eating chocolate?

MARK (X) ONE

Yes

No

Shape20

3.

Did you do any of the following last week?

MARK ALL THAT APPLY

Went to a play

Went to a movie

Attended a sporting event


Please answer the following questions as best you can. This first set of questions are about you.

Shape23

1.

How old are you?

MARK ONLY ONE ANSWER

10

11

12

13

14

15

16

17

18

19

20 or older

Shape24

2.

What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be in when you go back to school.)

MARK ONLY ONE ANSWER

9th

10th

11th

12th

My school does not assign grade levels

I dropped out of school, and I am not working on getting a high school diploma or GED

I am working toward a GED

I have a high school diploma or GED but I am not currently enrolled in college or technical school

I have a high school diploma or GED and I am currently enrolled in college or technical school

Shape25

3.

When you are at home or with your family, what language or languages do you usually speak?

MARK ALL THAT APPLY

English

Spanish

Other (please specify)



Shape26

4.

Are you Hispanic or Latino?

MARK YES OR NO

Yes

No

Shape27

5.

What is your race?

MARK ALL THAT APPLY

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White or Caucasian

Shape28

6.

What is your sex?

MARK only one answer

Male

Female


Shape29

7.

Are you currently…?

MARK ALL THAT APPLY

Living with family [parent(s), guardian, grandparents, or other relatives]

In foster care, living with a family

In foster care, living in a group home

Couch surfing or moving from home to home

Living in a place not meant to be a residence, such as outside, in a tent city or homeless camp, in a car, in an abandoned vehicle or in an abandoned building

Staying in an emergency shelter or transitional living program

Staying in a motel or hotel

In juvenile detention, jail, prison or another correctional facility, or under the supervision of a probation officer

None of the above

For questions 8-12, please think about how the program you just completed has affected you, even if your program did not cover the topic.

Shape30

8.

9. Has being in the program made you more likely, about the same, or less likely to… (Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

MARK ONLY ONE ANSWER PER ROW







Much more likely

Somewhat more likely

About the same

Somewhat less Likely

Much less likely

a. resist or say no to peer pressure?

Shape31

Shape32

Shape33

Shape34

Shape35

b. manage your emotions in healthy ways (for example, ways that are not hurtful to you or others)?

Shape36

Shape37

Shape38

Shape39

Shape40

c. work together to find a solution when you disagree with a friend?

Shape41

Shape42

Shape43

Shape44

Shape45

d. choose to spend time with friends that keep you out of trouble?

Shape46

Shape47

Shape48

Shape49

Shape50

e. make decisions to not use drugs and alcohol?

Shape51

Shape52

Shape53

Shape54

Shape55

f. be respectful of others?

Shape56

Shape57

Shape58

Shape59

Shape60

g. think about the consequences before making a decision?

Shape61

Shape62

Shape63

Shape64

Shape65



Shape66

9.

Has being in the program made you more likely, about the same, or less likely to…(Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

MARK ONLY ONE ANSWER PER ROW







Much more likely

Somewhat more likely

About the same

Somewhat less Likely

Much less likely

a. make plans to reach your goals?

Shape67

Shape68

Shape69

Shape70

Shape71

b. care about doing well in school?

Shape72

Shape73

Shape74

Shape75

Shape76

c. graduate high school or get your GED?

Shape77

Shape78

Shape79

Shape80

Shape81

d. get more education or training after high school or completing your GED?

Shape82

Shape83

Shape84

Shape85

Shape86

e. get a steady full-time job after school? .....................

Shape87

Shape88

Shape89

Shape90

Shape91


Shape92

10.

Has being in the program made you more likely, about the same, or less likely to… (Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

MARK ONLY ONE ANSWER PER ROW







Much more likely

Somewhat more likely

About the same

Somewhat less likely

Much less likely

a. save money to get things you want

Shape93

Shape94

Shape95

Shape96

Shape97

b. feel confident about how to open a bank account

Shape98

Shape99

Shape100

Shape101

Shape102

c. feel confident about how to prepare a budget

Shape103

Shape104

Shape105

Shape106

Shape107

d. feel confident about how to track your expenses

Shape108

Shape109

Shape110

Shape111

Shape112

e. understand the costs associated with raising a child

Shape113

Shape114

Shape115

Shape116

Shape117




Shape118

11.

12. Has being in the program made you more likely, about the same, or less likely to… (Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

MARK ONLY ONE ANSWER PER ROW







Much more likely

Somewhat more likely

About the same

Somewhat less Likely

Much less likely

a. talk with your parent, guardian, or caregiver about things going on in your life?

Shape119

Shape120

Shape121

Shape122

Shape123

b. talk with your parent, guardian, or caregiver about sex?

Shape124

Shape125

Shape126

Shape127

Shape128

c. feel comfortable talking with your parent, guardian, or caregiver about sex?

Shape129

Shape130

Shape131

Shape132

Shape133

d. speak up or ask for help if you are being bullied in person or online, via text, while gaming, or through other social media?

Shape134

Shape135

Shape136

Shape137

Shape138

e. speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media?

Shape139

Shape140

Shape141

Shape142

Shape143



Shape144

12.

Has being in the program made you more likely, about the same, or less likely to… (Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

MARK ONLY ONE ANSWER PER ROW







Much more likely

Somewhat more likely

About the same

Somewhat less Likely

Much less likely

a. better understand what makes a relationship healthy?

Shape145

Shape146

Shape147

Shape148

Shape149

b. look for information and resources about dating violence (for example, websites, social media, hotlines, organizations, etc.)?

Shape150

Shape151

Shape152

Shape153

Shape154

c. resist or say no to someone you are dating or going out with if they pressure you to participate in sexual acts, such as kissing, touching private parts, or sex? ……………..

Shape155

Shape156

Shape157

Shape158

Shape159

d. talk to a friend if someone you are dating or going out with makes you uncomfortable, hurts you or pressures you to do things you don’t want to do?

Shape160

Shape161

Shape162

Shape163

Shape164

e. talk to a trusted adult (for example, a family member, teacher, counselor, coach, etc.) if someone you are dating or going out with makes you uncomfortable, hurts you, or pressures you to do things you don’t want to do?

Shape165

Shape166

Shape167

Shape168

Shape169

f. talk to a trusted adult if someone other than the person you are dating or going out with makes you uncomfortable, hurts you or pressures you to do things you don’t want to do?

Shape170

Shape171

Shape172

Shape173

Shape174




Shape175

13.

For each of the items below, please mark how true each statement is of you.

MARK ONLY ONE ANSWER PER ROW



Not true at all

Somewhat true of me

Very true of me

a. I plan to delay having sexual intercourse until I graduate high school or receive my GED

Shape176

Shape177

Shape178

b. I plan to delay having sexual intercourse until I graduate college or complete another education or training program

Shape179

Shape180

Shape181

c. I plan to delay having sexual intercourse until I am married

Shape182

Shape183

Shape184

d. I plan to be married before I have a child

Shape185

Shape186

Shape187

e. I plan to have a steady full-time job before I get married

Shape188

Shape189

Shape190

f. I plan to have a steady full-time job before I have a child

Shape191

Shape192

Shape193



The next questions ask about sexual intercourse.

Shape194

14.

As a result of being in the program, are you planning to abstain from sexual intercourse (choose to not have sexual intercourse) for at least the next 3 months?

Shape196 Shape195

Yes GO TO QUESTION 15

Shape197

No GO TO QUESTION 16, NEXT PAGE

Shape198

Not sure GO TO QUESTION 16, NEXT PAGE

Shape199

15.

How important are each of these reasons in your decision to not have sexual intercourse for at least the next 3 months? (Note: Do not answer this question if you responded “No” or “Not sure” to question 15.)

MARK ONLY ONE ANSWER PER ROW



Not at all important

Not too important

Somewhat important

Very important

a. how it might affect your plans for the future

Shape200

Shape201

Shape202

Shape203

b. the possible emotional consequences (for example, feeling sadness or regret)

Shape204

Shape205

Shape206

Shape207

c. the possible social consequences (for example, get a bad reputation or have rumors spread about you, have to deal with drama, make your relationship with someone you are dating or going out with worse, or get in trouble with your parents)

Shape208

Shape209

Shape210

Shape211

d. the risk of getting a sexually transmitted infection (STI)

Shape212

Shape213

Shape214

Shape215

e. the risk of getting pregnant or getting someone pregnant

Shape216

Shape217

Shape218

Shape219




I F YOU ANSWERED QUESTION 15, GO TO QUESTION 17

IF YOU ANSWERED “NO” OR “NOT SURE” TO QUESTION 14: SKIP QUESTION 15 AND GO TO QUESTION 16 ON THE NEXT PAGE


Shape220

16.



The next few questions refer to sexual intercourse and your risk of pregnancy and sexually transmitted infections (STIs). Remember, all of your responses will be kept private. (Note: Do not answer this question if you responded “Yes” to question 14.)

Has being in the program made you more likely, about the same, or less likely to…(Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

  1. have sexual intercourse in the next 3 months?

MARK ONLY ONE ANSWER

Much more likely

Somewhat more likely

About the same

Somewhat less likely

Much less likely

b. use (or ask your partner to use) a condom if you were to have sexual intercourse in the next 3 months?

MARK ONLY ONE ANSWER

This question does not apply to me because I choose to not have sexual intercourse
in the next 3 months

Much more likely

Somewhat more likely

About the same

Somewhat less likely

Much less likely

c. use (or ask your partner to use) birth control OTHER than condoms if you were to have sexual intercourse in the next 3 months? By birth control, we mean methods that can prevent pregnancy, like using birth control pills, the shot, the patch, the ring, IUD, or implant.

MARK ONLY ONE ANSWER

This question does not apply to me because I choose to not have sexual intercourse
in the next 3 months

Much more likely

Somewhat more likely

About the same

Somewhat less likely

Much less likely




The next questions ask you about your experiences in the program that you just completed. Think about all of the sessions or classes of the program that you attended.

Shape221

17.

Even if you didn’t attend all of the sessions or classes in this program, how often in this program

MARK ONLY ONE ANSWER PER ROW



All of the Time

Most of the Time

Some of the Time

None of the Time

a. did you feel interested in program sessions and classes?

Shape222

Shape223

Shape224

Shape225

b. did you feel the material presented was clear?

Shape226

Shape227

Shape228

Shape229

c. did discussions or activities help you to learn program lessons?

Shape230

Shape231

Shape232

Shape233

d. did you have a chance to ask questions about topics or issues that came up in the program?

Shape234

Shape235

Shape236

Shape237

e. did you feel respected as a person?

Shape238

Shape239

Shape240

Shape241

f. were you picked on, teased, or bullied in this program?

Shape242

Shape243

Shape244

Shape245


Shape246

18.

Now thinking about all youth in this program, how often…

MARK ONLY ONE ANSWER PER ROW



All of the Time

Most of the Time

Some of the Time

None of the Time

a. were any youth in this program picked on, teased, or bullied?

Shape247

Shape248

Shape249

Shape250









Shape251

19.

Thinking about the program, how satisfied are you with…

MARK ONLY ONE ANSWER PER ROW



Very satisfied

Somewhat satisfied

A little satisfied

Not at all satisfied

a. the amount of information you received about abstaining from sex (choosing to not have sex)?

Shape252

Shape253

Shape254

Shape255

b. the amount of information you received about condoms and birth control?

Shape256

Shape257

Shape258

Shape259


Thank you for participating in this survey!

1


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePREP ENTRY-EXIT SURVEY
SubjectNON STANDARD SAQ
AuthorMATHEMATICA STAFF
File Modified0000-00-00
File Created2021-04-12

© 2024 OMB.report | Privacy Policy