Pre Regional Evaluation form

REGIONAL T/TA

OMB Control Number: ####-####
Expiration Date: ##/##/####

Pre-T/TA Evaluation

In order to help the Office of Victims of Crime Tribal Financial Management Center (TFMC) 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. If you have any questions about this evaluation, please contact
[email protected]
Please provide the information below to create an anonymous ID:
______

______

______

Birth Month
(insert just the month
for your date of birth,
example: 08 for August)

First letter of first name
(example: S for Sara)

First letter of your middle name
(example: M for Maria)

T/TA: ______________________________________________________________ DATE(S): _______________________
CONSULTANT FACILITATOR(S): ______________________________________________________________________
TFMC COORDINATOR: _____________________________________________________________________________
Please indicate the extent to which you agree or disagree with each statement.
Strongly
Disagree

Disagree

Agree

Strongly
Agree

1.

I [insert objective].

1

2

3

4

2.

I [insert objective].

1

2

3

4

3.

I [insert objective].

1

2

3

4

4.

I [insert objective].

1

2

3

4

5.

I [insert objective].

1

2

3

4

6.

Which of the following best describes your organization?
Tribal government (e.g., governance, administration, support personnel)
Tribal program
Tribal consortium
Nonprofit organization
Other (please specify): _______________________________

7.

8.

What is your organization’s geographical service area?
Reservation
Urban
Suburban
What is your role in your organization?
Program
Finance
Grant coordinator

Rural
Frontier

Tribal leader
Other (please specify):
___________________

Thank you for taking the time to complete this form and helping to improve OVC TFMC activities.
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 1 minute. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the TFMC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.