Form 1 Creative Forces Program Feedback Survey

ATTACHMENT A
CREATIVE FORCES PROGRAM FEEDBACK SURVEY
FINAL – JANUARY 10, 2022
Thank you for participating in a program supported by a Creative Forces Community Engagement grant.
This grant program, supported by the National Endowment for the Arts in cooperation with the MidAmerica Arts Alliance, aims to improve the health, well-being, and quality of life for military service
members and veterans as well as their families and caregivers.
This brief survey will collect your feedback about your experiences in this program. Your responses will
remain anonymous and will be used only to report on the effectiveness of current programming and to
improve future programs. Your responses will not be associated with, nor have any influence on, your
relationship with the program provider, Mid-America Arts Alliance, or the National Endowment for the
Arts.
Your participation is voluntary. You will not receive any compensation for responding to the survey. You
may decline to answer any questions you wish. Under the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless such collection displays a valid Office of
Management and Budget (OMB) control number. The OMB control number for this survey is OMB No.
XXXX-XXXX (expires XX/XX/XXXX). The time required to provide responses to the survey questions is
estimated to be approximately 5 minutes. Please contact the Mid-America Arts Alliance at
[email protected] or the National Endowment for the Arts at [email protected] if you have any
questions regarding the estimated time burden or any other aspect of this data collection.
Click here to begin.
[Page break]
1. How did you hear about our program? [Select all that apply]
o
o
o
o
o
o
o
o
o
o
o

Website
Printed brochure or flyer
Email promotion
Facebook
Twitter
Newspaper story or announcement
Radio announcement
Internet search
I was involved in another program/event with this organization
Someone I know told me about it
Other (please specify)
Neither
Strongly
Strongly
Disagree Agree or Agree
Agree
Disagree
Disagree
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2. The program’s schedule (time of day, day of
week, etc.) worked for me.
3. I felt welcome in this program.
4. I felt engaged during this program.
5. The program created a sense of community
and belonging.
6. Any comments about these aspects of the program? [500 character limit]

Neither
Strongly
Strongly
Disagree Agree or Agree
Agree
Disagree
Disagree
7. I benefited from this program.
8. The greatest benefits were: [list up to 3]
9. During this program, I gained new
knowledge/skills or significantly enhanced
my knowledge/skills.
10. In what ways might you use your skills/knowledge in the future? [300 character limit]
11. The most challenging things about the program were: [list up to 3]

Very
Unlikely

12. How likely are you to participate in another
program with us?
13. How likely are you to recommend it to a friend,
family member, or colleague?
14. For both questions, why or why not? [300 character limit]

Somewhat Somewhat
Unlikely
likely

15. What types of arts programs would you like to participate in?
[300 character limit]

16. Have you participated in or attended other programs here (or with this organization) in the
past?

o Yes
o No
o Unsure
2

Very
likely

If yes, please name or briefly describe the program(s): [300 character limit]

17. Do you have any suggestions/comments that will help us make the program better? [300
character limit]
[300 character limit]

Optional: Please tell us a little about yourself. This information will help us understand who is
participating in the program and whether there are changes we need to make to ensure the program
is beneficial to everyone.
18. Which best describes you? (check all that apply)

o Service Member

o Veteran

o
o
o

Active Duty
National Guard
Reserve

o

Retiree

o Spouse/Partner of a Service Member or Veteran

o

o
o
o
o
o

o Active Duty Service Member
o National Guard/Reserve
o Veteran
Other Family Member of a Service Member or Veteran
o Active Duty
o National Guard/Reserve
o Veteran
Caregiver for a
o Service Member
o Veteran
Health care worker serving military-connected populations
Civilian
Other ________
Prefer not to say

19. What is your age?

o
o
o
o

0 – 17 years
18 – 24 years
25 – 64 years
65+ years

20. Which best describes you? (check all that apply)

o American Indian or Alaska Native
o Asian
o Black or African American

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o
o
o
o
o

Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other Racial/Ethnic Group
Prefer not to say

21. Do you identify as:

o Female
o Male
O Prefer not to say

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