Form 1 Mental Health and Well Being feedback

MENTAL HEALTH & WELLNESS SERIES - FEEDBACK
OMB Number: 0925-0648
Expiration Date: 30 June 2024
Burden Time: 5 minutes

GENERAL INFORMATION
What is your a!liation?:*

What is your educational or professional status?:*

How did you participate in this webinar?:*

SATISFACTION OF WEBINAR
Overall, how would you rate this webinar?:*
excellent

very good

good

fair

poor

How likely are you to recommend this webinar to a friend or colleague?:
very likely
unlikely

somewhat likely

neither likely or unlikely

somewhat unlikely

How would you rate the panelists for this webinar?:
excellent

very good

good

fair

poor

This webinar was informative.:
strongly agree

agree

neutral

disagree

strongly disagree

neutral

disagree

strongly disagree

This webinar was valuable:
strongly agree

agree

INFORMATION LEARNED AND IMPACT
What percentage of the information was new to you?*

very

100%

75%

50%

25%

0%

I intend to share information learned in this webinar with a colleague or a friend.
strongly agree

agree

neutral

disagree

strongly disagree

The webinar has changed the way I think about mental health and well-being.
strongly agree

agree

neutral

disagree

strongly disagree

The webinar has provided me with the tools to cope.
strongly agree

agree

neutral

disagree

strongly disagree

The webinar has provided me with the tools to support others.
strongly agree

agree

neutral

disagree

strongly disagree

This webinar has raised my awareness of importance of mental health and wellness in successful
scientific careers.
strongly agree

agree

neutral

disagree

strongly disagree

I believe webinars like this can change the culture of mental health and well-being in science
careers.
strongly agree

agree

neutral

disagree

strongly disagree

What was your biggest takeaway from the webinar?:

What can we do to improve the webinar?:

SMALL GROUP DISCUSSIONS
Did you participate in a small group facilitated session?:*
yes

no

The small group session enabled me to practice what I learned in the webinar.:
strongly agree

agree

neutral

disagree

strongly disagree

The small group session helped me implement what I learned in the webinar.:
strongly agree

agree

neutral

disagree

strongly disagree

I felt comfortable discussing various issues in the small group session.:
strongly agree

agree

neutral

disagree

strongly disagree

The small group session participant size was:
too large

a bit large

just right

a bit small

too small

If you have any feedback or comments regarding the small discussion group, please let us know.
below. If possible, please provide the name of the facilitator.:

Public reporting burden for this collection of information is estimated to average 5-minutes per
submission. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
7974, Bethesda, MD 20892-7974, ATTN: PRA 0925-0648. Do not return the completed form to this
address.
Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285).
Rights of participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are
no penalties for not participating or withdrawing from the study at any time. The information collected
in this study will be kept private to the extent provided by law. Names and other identifiers will not
appear in any report of the study. Information provided will be combined for all participants and
reported as summaries.

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