Customized TA Participant feedback form

CUSTOMIZED TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

In order to help OVC TTAC better serve the field, we would like 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. Your participation in this survey is completely voluntary. If you have any questions about this survey
or the evaluation, please contact [email protected].
EVENT:

SESSION:

LOCATION:

DATE(S):

PRESENTER(S):
LEARNING OBJECTIVES: SEE LAST PAGE

Email: _________________________
Please rate your level of confidence in your ability to:

CONFIDENCE CAPACITY-BUILDING MEASURE:
_______________
1.
2.
3.
4.
5.
6.
7.

[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].

KNOWLEDGE CAPACITY-BUILDING MEASURE:
_______________
8.
9.
10.
11.
12.
13.
14.

[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].

SKILLS CAPACITY-BUILDING MEASURE:
_______________
15.
16.
17.
18.
19.
20.
21.

[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].
[insert capacity-building objective].

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1
1
1

2
2
2
2
2
2
2

3
3
3
3
3
3
3

4
4
4
4
4
4
4

5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA

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 10 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the OVC TTAC evaluation team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

CUSTOMIZED TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback
Please indicate the extent to which you agree or disagree with the following statements.

PRESENTER/FACILITATOR 1: ___________________
22. The presenter demonstrated a comprehensive knowledge of the
subject.
23. The presenter clearly and logically presented the content.
24. The presenter responded well to questions and comments.
25. The presenter created a respectful environment for participants.

PRESENTER/FACILITATOR 2: ___________________
26. The presenter demonstrated a comprehensive knowledge of the
subject.
27. The presenter clearly and logically presented the content.
28. The presenter responded well to questions and comments.
29. The presenter created a respectful environment for participants.

OVERALL SESSION

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

5

NA

1
1
1

2
2
2

3
3
3

4
4
4

5
5
5

NA
NA
NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1

2

3

4

5

NA

1
1
1

2
2
2

3
3
3

4
4
4

5
5
5

NA
NA
NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

30. The session clearly addressed the learning objectives. (See last page
1
2
3
4
5
NA
for learning objectives.)
31. The session addressed the critical issues related to the topic(s).
1
2
3
4
5
NA
32. The time allotted was adequate for the scope of material covered.
1
2
3
4
5
NA
33. The session was well organized and clear.
1
2
3
4
5
NA
34. The content was appropriate for my level of experience and
1
2
3
4
5
NA
knowledge.
35. The resource materials (handouts, audiovisuals, PowerPoints)
1
2
3
4
5
NA
enhanced the session.
36. The session increased my knowledge related to the topic(s).
1
2
3
4
5
NA
37. The session increased my practical skills related to the topic(s).
1
2
3
4
5
NA
38. I will be able to apply what I learned in my work.
1
2
3
4
5
NA
39. The session improved my ability to serve victims.
1
2
3
4
5
NA
40. The session improved my ability to reach underserved victims.
1
2
3
4
5
NA
41. The session provided sufficient opportunity to network with others
1
2
3
4
5
NA
in the field.
42. The interactive features and or activities (e.g. example of interactive
1
2
3
4
5
NA
feature used in specific TTA inserted) enhanced my experience.
43. The small group activity enhanced my experience.
1
2
3
4
5
NA
44. The session met my professional needs.
1
2
3
4
5
NA
45. I am satisfied with the overall quality of the session.
1
2
3
4
5
NA
Following the training, what three steps will you take to better serve victims of crime following this [TTA]?
a. ___________________________________________________________________________________
b. ___________________________________________________________________________________
c. ___________________________________________________________________________________
As a result of participating in this session, please rate your level of confidence in your likelihood to do any of the following:

46.
47.
48.
49.
50.

Share material with colleagues
Refer colleagues to other OVC TTAC events/resources
Train/educate others in content/skills learned
Pursue additional professional development
Develop/strengthen use of technology or infrastructure

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

5
5
5
5
5

NA
NA
NA
NA
NA

Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.

CUSTOMIZED TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.

Develop/strengthen collaborative or strategic relationships
Expand services to new victim populations
Expand types of services offered to victims
Strengthen administrative capacity to better serve victims of crime
(e.g., financial management, develop a board of directors)
Enact policy changes at my organization
Begin a new project or initiative
Change my management, leadership, or interpersonal
communication style
Strengthen evaluation or needs assessment activities
Network with other participants
Identify/pursue new funding resources

61. Implement/change financial procedures
62. Modify outreach/marketing activities
63. Develop/enhance vision, mission, or strategic plan

1
1
1

2
2
2

3
3
3

4
4
4

5
5
5

NA
NA
NA

1

2

3

4

5

NA

1
1

2
2

3
3

4
4

5
5

NA
NA

1

2

3

4

5

NA

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

5
5
5
5
5
5

NA
NA
NA
NA
NA
NA

Please specify any other actions you plan to take as a result of this session that are not listed in the table above.

____________________________________________________________________________________
64. Please explain in detail any ways this session improved your organization’s capacity to better serve victims of crime:

___________________________________________________________________________________
___________________________________________________________________________________
64. Would you recommend OVC TTAC to others?

□ Yes

□ No

65. What aspects of the session were most helpful and why?

____________________________________________________________________________________
____________________________________________________________________________________
66. What could be done differently to improve the session?

____________________________________________________________________________________
____________________________________________________________________________________
67. Do you have any other comments or suggestions?

____________________________________________________________________________________
____________________________________________________________________________________
68. Following this session, what additional resource or trainings could OVC TTAC provide to support you and your organization?

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.

CUSTOMIZED TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback
69. How often have you engaged with OVC TTAC in the last 12 months? (Mark one.)
□ 1–3 times
□ 4–6 times

□ 7–9 times
□ 10+ times

70. Which of the following best describes your gender identity? (Mark one.)
□ Male
□ Female
□ Transgender Male

□ Transgender Female
□ Genderqueer/NonConforming/
Non-Binary

□ Two-Spirit
□ Not Listed (option to specify):
_________________________

71. Which of the following best describes your race/ethnicity? (Mark all that apply.)
□
□
□
□

American Indian or Alaska Native
Asian
Black/African American
Hispanic/Latino

□ Native Hawaiian or
Pacific Islander
□ White Non-Latino or
Caucasian

□ Not Listed (option to specify):
_________________________

72. Which of the following best describes the organization in which you work? (Mark all that apply.)
□
□
□
□

Community-Based/Grassroots
Criminal Justice Agency
Education
Faith-Based

□
□
□
□

Health/Mental Health Services
Human/Social Services
Legal Services
Legislation/Policymaking

□ Military
□ Research
□ Other (please specify):
_________________________

73. Which types of victim services do you provide for crime victims in your current position? (Mark all that apply.)
□
□
□
□
□

I do not provide direct services
Child Care
Compensation/Restitution
Counseling
Crisis Intervention

□ Criminal Justice System
Advocacy/Assistance
□ Housing/Shelter
□ Information/Referral
□ Medical/SANE/SART

□
□
□
□

Notification
Transportation
24-Hour Hotline
Other (please specify):
_________________________

74. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years

□ 3 to 5 years

□ 6 to 10 years

□ More than 10 years

75. Which of the following best describes your primary role in your current position? (Mark all that apply.)
□ Direct Delivery/Front Line Staff
□ Management/Administrative Staff

□ Consultant/Trainer
□ Volunteer

□ Other (please specify):
_________________________

76. Which of the following best describes the population you serve? (Mark all that apply.)
□
□
□
□

National
State
Tribal
International, list country:
_________________________________

□ Local
□ Urban
□ Rural
□ Suburban
□ Culturally specific population(s): ________________________

Thank you for taking the time to complete this form and helping to improve OVC TTAC activities.

CUSTOMIZED TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

Please use the learning objectives listed below to answer question #9.

LEARNING OBJECTIVES: