Intensive TA Participant feedback form

INTENSIVE 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. Answers to these questions will be reported after aggregating all responses. Your participation in
this survey is completely voluntary. If you have any questions about this survey or the evaluation, please contact
[email protected].
EVENT/ASSISTANCE:

SESSION:

LOCATION:

DATE(S):

PRESENTER(S):
LEARNING OBJECTIVES:

Before we begin, please provide your email address.
Email addresses enable us to track your participation across OVC TTAC offerings and your preferences/insights provided. You will be
prompted to provide this same email address each time. If you do not have an email address or prefer to use an anonymous identifier,
create a username to be used and retained for future OVC TTAC evaluations.
Username example: provide your two-digit birth month, first initial, middle initial (e.g., 08JD)
Email or Username:: _________________________
Please rate your level of confidence in your ability to:

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].

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

As a result of [technical assistance], please rate your skill level in the following areas:

8.
9.
10.
11.
12.
13.
14.

[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance 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

As a result of [technical assistance], please rate your level of knowledge in the following areas:

15.
16.
17.
18.
19.

[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].
[insert technical assistance objective].

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

INTENSIVE TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

20. [insert technical assistance objective].
21. [insert technical assistance objective].

1
1

2
2

3
3

4
4

5
5

NA
NA

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./The facilitator helped the meeting to stay on track with the
scheduled agenda.
23. The presenter clearly and logically presented the content./The
facilitator managed the discussion well, allowing and encouraging
multiple people to share feedback.
24. The presenter/facilitator responded well to questions and
comments.
25. The presenter/facilitator 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

2

3

4

5

NA

1

2

3

4

5

NA

1

2

3

4

5

NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

26. The session/assistance clearly addressed the learning
1
2
3
4
5
NA
objectives/stated objectives. (See above for learning objectives.)
27. The session/assistance addressed the critical issues related to the
1
2
3
4
5
NA
topic(s).
28. The time allotted was adequate for the scope of material covered.
1
2
3
4
5
NA
29. The session/assistance was well organized and clear.
1
2
3
4
5
NA
30. The content was appropriate for my level of experience and
1
2
3
4
5
NA
knowledge.
31. The resource materials (handouts, audiovisuals, PowerPoints)
1
2
3
4
5
NA
enhanced the session.
32. The session/assistance increased my knowledge related to the
1
2
3
4
5
NA
topic(s).
33. The session/assistance increased my practical skills related to the
1
2
3
4
5
NA
topic(s).
34. I will be able to apply what I learned in my work.
1
2
3
4
5
NA
35. The session/assistance improved my ability to serve victims.
1
2
3
4
5
NA
36. The session/assistance improved my ability to reach underserved
1
2
3
4
5
NA
victims.
37. The session/assistance improved my ability to collaborate with
1
2
3
4
5
NA
others.
38. The session/assistance provided sufficient opportunity to network
1
2
3
4
5
NA
with others in the field.
39. The [small group activities/discussion, etc.] enhanced my
1
2
3
4
5
NA
experience.
40. The session/assistance met my professional needs.
1
2
3
4
5
NA
41. I am satisfied with the overall quality of the session/assistance.
1
2
3
4
5
NA
What three steps will you take to better serve victims of crime as a result of this [TTA]?
a. ___________________________________________________________________________________
b. ___________________________________________________________________________________
c. ___________________________________________________________________________________

Please indicate the extent to which you agree or disagree with the following statements:

INTENSIVE TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

TTA ACTIVITY: ___________________
42.
43.
44.
45.
46.
47.
48.
49.

[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]

TTA ACTIVITY: ___________________
50.
51.
52.
53.
54.
55.
56.
57.

[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]

T/TA ACTIVITY: ___________________
58.
59.
60.
61.
62.
63.
64.
65.

[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]
[insert TTA activity objective]

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA
NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA
NA

Strongly
Disagree

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
NA
NA
NA

As a result of participating in this session, please rate your level of confidence in your likelihood to do any of the following:

66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.

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
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

Very Low

Low

Moderate

High

Very
High

Not
Applicable

1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5

NA
NA
NA
NA
NA
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

2

3

4

5

NA

INTENSIVE TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

79. Network with other participants
80. Identify/pursue new funding resources

1
1
1
1
1

81. Implement/change financial procedures
82. Modify outreach/marketing activities
83. Develop/enhance vision, mission, or strategic plan

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

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

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

____________________________________________________________________________________
____________________________________________________________________________________
□ Yes

85. Would you recommend OVC TTAC to others?

□ No

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

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

____________________________________________________________________________________
____________________________________________________________________________________
88. Following this [TTA], how prepared do you feel to take steps toward [insert main TTA objective] in your organization?
1

2

3

4

Not At All Prepared

Somewhat Prepared

Mostly Prepared

Completely Prepared

89. Please indicate what aspects of the technical assistance were most helpful to achieving each objective.
Learning Objective 1

Learning Objective 2

Learning Objective 3

Learning Objective 4

Element of Technical
Assistance 1
Element of Technical
Assistance 2
Element of Technical
Assistance 3
Element of Technical
Assistance 4
90. What could OVC TTAC do in the future to enhance your level of preparedness during this [type of TTA]?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
91. What could OVC TTAC do in the future to enhance your level of preparedness following this [type of TTA]?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
92. Was there sufficient time allotted to meet the goals of this technical assistance? Are there areas where you would have liked
more time for input or development?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

INTENSIVE TA

OMB#: 1121-XXXX
Date of Expiration: XXXX

Participant Feedback

93. Do you have any other comments or suggestions?

____________________________________________________________________________________
____________________________________________________________________________________
94. 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

95. 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):
_________________________

96. 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):
_________________________

97. 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):
_________________________

98. 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):
_________________________

99. 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

100. 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):
_________________________

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

National
□ Local
State
□ Urban
Tribal
□ Rural
International, list country:
□ Suburban
_________________________________
102. Please provide your city and state (i.e., location of organization or professional address).

___________________________________________________________________________________
103. Please list any marginalized or underserved populations you serve.

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

INTENSIVE TA
Participant Feedback

OMB#: 1121-XXXX
Date of Expiration: XXXX

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