Coaching Companion Questionnaire

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Coaching Companion Questionnaire

Coaching Companion Questionnaire

OMB: 0970-0401

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THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average approximately 7 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.

Coaching Companion Questionnaire OMB #: 0970-0401, Exp. Date: 05/31/2021

The Coaching Companion is a video sharing and coaching feedback app. Teachers, family child care providers, home visitors, education managers, coaches, and others can share video files, ask questions, exchange feedback, and develop individualized coaching plans that support quality teaching and positive outcomes for young children.

The Coaching Companion is designed to support three components of the Practice-Based Coaching (PBC) model: Shared Goals and Action Planning, Focused Observation, and Reflection and Feedback. It also promotes the overall use of effective teaching practices.

Your responses to this questionnaire will help us better understand coaching within your program or organization. After we receive your completed questionnaire, a member of our team may contact you to discuss how the Coaching Companion can best support your coaching needs and plans.

Thank you for your interest in the Coaching Companion!

Items marked with an asterisk (*) are required.

Please tell us about:

Yourself

First and Last Name*Shape1

Email Address*Shape2

Job Title*Shape3

Your Program

Name of Program*Shape4

Name of Grantee

If representing a Head Start program, including Early Head Start and Migrant and Seasonal Head Start

Shape5

State or Territory*

[Drop-down listing states and territories]


Region

For all Head Start programs

[Drop-down listing 12 regions]

Setting

UrbanShape6

RuralShape7

Tribal CommunityShape8

Migrant and SeasonalShape9

Coaching in Your Program

Do teachers, family child care providers, or home visitors already receive coaching?*

[Drop-down for Yes or No]

Who provides, or will provide, coaching in your program?

In-house staffShape10

ConsultantShape11

PeerShape12

OtherShape13

No coachingShape14


Please briefly describe your coaching model.

*Shape15


Have you or your program’s staff used the 15-minute in-service suites located on the Early Childhood Learning and Knowledge Center (ECLKC)?*

https://eclkc.ohs.acf.hhs.gov/professional-development/article/15-minute-service-suites

[Drop-down for Yes or No]

If so, please describe how you have used them.

Shape16


Have you or your program’s staff attended any PBC workshops or events?*

[Drop-down for Yes or No]

If so, please list the event(s).

Shape17


How many teachers, family child care providers, or home visitors will be using the Coaching Companion?*Shape18


How many coaches will use the Coaching Companion?*Shape19

What content areas or teaching practices will coaching be focused upon?*Shape20

Available Technology within Your Program

Do teachers, family child care providers, and home visitors in your program have access to a computer with high-speed Internet?*

[Drop-down for Yes or No]


Can teachers, family child care providers, and home visitors view streaming video on your program’s computers?*

[Drop-down for Yes or No]


Do coaches, teachers, family child care providers, and home visitors in your program have access to a digital video camera to record classroom or home visit interactions so they can upload videos to the Coaching Companion?*

[Drop-down for Yes or No]


3. Has your organization been granted access to a Coaching Companion account before?*

[Drop-down for Yes, No, or I don’t’ know]


Organization Administrator Name*

If your organization is granted access to Coaching Companion, the administrator will create users on the organization account. The administrator can transfer the role to another user if necessary.

Shape21


Organization Administrator Email Address*Shape22


Additional Comments

Shape23

Shape24 Send me a copy of my responses


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJesse Escobar
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File Created2021-05-04

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