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pdfHUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
In order to help National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we are
reaching out to obtain your feedback prior to the start of the fellowship program. 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. Summary responses will only be
shared to enhance the experience and leadership training program in the future.
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)
1.
First letter of first name
(example: S for Sara)
First letter of your middle name
(example: M for Maria)
Have you received prior leadership training?
□ Yes
□ No
If yes, please provide a brief description (e.g., what you learned, when you received training, and the length of that training):
2.
Please think about someone who you believe is an outstanding leader, and provide 2–3 examples of why. To protect the
privacy of others, please do not list specific names or details.
3.
Describe a recent experience (either big or small) where you exercised leadership. To protect the privacy of others, please do
not list specific names or details.
4.
What do you think is your leadership style (i.e., supportive, organized, action-oriented)?
5.
What are the top three ways you would like to improve your effectiveness as a leader?
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
HUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
Please rate the importance to you for achieving each of the program’s goals:
PROGRAM OBJECTIVES
Unimportant
Somewhat
Important
Important
Very
Important
Not
Applicable
6.
[insert objective here].
1
2
3
4
NA
7.
KNOWLEDGE: Grow participant understanding of
human trafficking programs, nonprofits, government,
public health systems, and other processes and
services that can help catalyze positive change.
1
2
3
4
NA
TRUST: Increase the level of trust and reciprocity
between survivors and the agencies and institutions
committed to their success.
1
2
3
4
NA
NETWORK: Cultivate a thriving leadership network
of survivors and human trafficking professionals that
work across organizational and geographic
boundaries.
1
2
3
4
NA
10. CONTRIBUTION: Create relevant and usable
resources and tools that enhance trauma-informed
and survivor-centered OTIP grant programming.
1
2
3
4
NA
11. SKILLS: Empower emerging leaders with leadership
skills and training to lead themselves and their
communities forward.
1
2
3
4
NA
8.
9.
12. What insights do you want to contribute to the other fellows' learning experiences during the program?
13. What contributions are you hoping the other fellows will make toward your learning experience?
Please rate your level of confidence with the following:
Not at All
Confident
Somewhat
Confident
Confident
Very
Confident
14. [insert leadership skill here].
1
2
3
4
15. [insert leadership skill here].
1
2
3
4
SKILL DEVELOPMENT
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
HUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
16. [insert leadership skill here].
1
2
3
4
17. [insert leadership skill here].
1
2
3
4
18. [insert leadership skill here].
1
2
3
4
19. My skills and knowledge about trauma-informed
practices.
1
2
3
4
20. My skills and knowledge about survivor-informed
practices.
1
2
3
4
21. My skills and knowledge about current evidencebased or promising practices.
1
2
3
4
22. My skills and knowledge about a multidisciplinary
approach to addressing human trafficking.
1
2
3
4
23. My skills and knowledge about a public health
approach to addressing human trafficking.
1
2
3
4
24. My connection to colleagues, professionals, and
human trafficking experts.
1
2
3
4
25. My knowledge of human trafficking programs,
nonprofits, government, and public health systems.
1
2
3
4
26. My ability to collaborate across human trafficking
programs or initiatives.
1
2
3
4
27. Please list any other professional goals you have for participating in this program:
28. What do you anticipate will be your greatest challenge in the Human Trafficking Leadership Academy (HTLA) fellowship
program?
29. Have you participated in survivor-informed training or curriculum previously?
□ Yes
□ No
If yes, please explain:
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
HUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
30. Have you participated in anti-trafficking initiatives prior to this program?
□ Yes
□ No
If yes, please explain:
31. FOR SURVIVORS: How was your experience engaging with grantees prior to this leadership training? If not applicable,
write “N/A.”
32. FOR GRANTEES: How was your experience engaging with survivors as professionals prior to this leadership training? If not
applicable, write “N/A.”
33. What do you see as the greatest barriers to leadership development for survivors of human trafficking?
34. What opportunities will this leadership training provide you with in the future?
35. How do you think this leadership training will impact the human trafficking field?
Please click the number that best represents your rating for each of the following questions.
36. How satisfied were you with the participation selection process for this program?
1
2
3
4
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
37. How satisfied were you with your preparedness to participate in the program when you were invited by NHTTAC?
1
2
3
4
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
HUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
38. What could be done differently in the participant selection process for this program?
39. How many times have you interacted with NHTTAC staff in preparation for this program?
□ 0–1
□ 2–3
□ 4–5
□6+
Please indicate the extent to which you agree or disagree with the following statements.
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not
Applicable
40. NHTTAC was well organized in the planning of the HTLA.
1
2
3
4
NA
41. NHTTAC was responsive to my questions and needs.
1
2
3
4
NA
42. NHTTAC provided me with the necessary information and
resources to help me prepare for the program.
1
2
3
4
NA
43. NHTTAC helped me adequately prepare for the program.
1
2
3
4
NA
PLANNING OF THE PROGRAM
44. How can NHTTAC [and insert consultants, if applicable] help support you in achieving your goals for this program?
45. What else would have been helpful in preparing for this program?
46. What obstacles or challenges, if any, did you encounter in the planning of the HTLA?
47. What could be done differently to improve NHTTAC’s support in the planning of the HTLA?
48. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at
risk of being trafficked, or has been trafficked?
1
2
3
4
Never
Occasionally
Frequently
Daily
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
HUMAN TRAFFICKING
LEADERSHIP ACADEMY
FELLOWSHIP PREPROGRAM
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Feedback
49. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
□ N/A
50. How does your agency currently provide survivor-informed services?
□ N/A
51. Do you have any other comments or suggestions?
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.25 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.
| File Type | application/pdf |
| File Title | 5 - HTLA Feedback Pre Program.docx |
| Author | Field, Michael |
| File Modified | 2020-03-20 |
| File Created | 2020-03-20 |